Which patients are suitable candidates for ambulatory adenotonsillectomy?
Although adenotonsillectomy has been performed on an ambulatory basis for many years, most are now per-formed on an ambulatory basis due to economic pressures. Appropriate reluctance exists to performing ambulatory adenotonsillectomy on patients less than 3 years of age. This group appears to be at increased risk for airway obstruc-tion, hemorrhage and, most importantly, hypovolemia.
Hypovolemia often results from inadequate oral consump-tion. Regardless of age, children with coexisting medical conditions may be poor candidates for outpatient adeno-tonsillectomy. Conditions associated with narrow airways place patients at increased risk for obstruction postopera-tively. Examples of these syndromes were mentioned in question 1. They include Treacher-Collins syndrome, Crouzon syndrome, Apert syndrome, Down syndrome, and mucopolysaccharidoses. Even normal amounts of pharyngeal lymphoid may obstruct the airway of patients with these problems. Subsequent postoperative edema may lead to severe obstruction. Observation in the intensive care unit may be warranted for patients with complicated medical problems, syndromes, and those who are unable to understand instructions.
For most patients undergoing ambulatory adenotonsil-lectomy, 4–8 hours of postanesthesia care unit observation are recommended before discharge from the hospital or ambulatory surgical facility.