TYK174
Acceptable anesthetic techniques for adenotonsillectomy in an otherwise healthy 5 year old 25 kg boy with mild obstructive sleep apnea include:
a) intravenous induction-muscle relaxation-intubation-sevoflurane maintenanceneuromuscular block reversal-awake extubation
b) inhalation induction-peripheral intravenous line-laryngeal mask (LMA)- sevoflurane maintenance-LMA removal deep
c) intravenous induction-LMA placement-propofol and remifentanil maintenance-LMA removal in Post Anesthesia Care Unit awake
d) inhalation -peripheral intravenous line-intubation-isoflurane maintenancedeep extubation
e) all of the above
f) none of the above
Answer
Answer e.
There is no known single best anesthetic technique for adenotonsillectomy - most modern volatile anesthetics as well as propofol-based total intravenous anesthetic techniques are widely used. In the standard risk population the airway can be managed with an endotracheal tube or with a laryngeal mask if no contraindications exist and the surgeon is amenable to the technique. Deep extubation is controversial but is not contraindicated in the otherwise healthy patient.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.
Keywords