Anaesthesia for elective ear, nose and throat surgery in children

This review outlines anaesthetic considerations for commonly performed elective ear, nose and throat procedures, which constitute a major portion of the paediatric anaesthesia workload. Most routine surgery can be performed on a daycare basis, but careful preoperative assessment is vital to identify those patients who are unsuitable for daycare surgery owing to complications of their presenting illness (e.g. obstructive sleep apnoea; OSA) or other co-morbidities. Children undergoing middle ear surgery need special attention to prevent bleeding, hypothermia and postoperative nausea and vomiting (PONV). Adenotonsillectomy is most commonly performed to relieve the symptoms of OSA. The main anaesthetic concerns are analgesia, PONV, risk of postoperative haemorrhage and postoperative disposition. Daycare tonsillectomy involves careful patient selection and good communication with families regarding the postoperative phase and potential complications. Use of lasers is common in airway surgery; associated risks include airway fire and injury to the eyes of the patient and theatre staff.