In the Journals

Preoperative albuterol reduces respiratory adverse events after tonsillectomy

Children who received albuterol before undergoing tonsillectomy were significantly less likely to experience respiratory adverse events, including laryngospasm and oxygen desaturation, compared with children who received a placebo, according to findings from a randomized clinical trial.

Britta S. von Ungern-Sternberg, MD, PhD, professor in department of emergency medicine within the faculty of health and medical sciences at the University of Western Australia, and colleagues wrote that even though the safety of pediatric anesthesia has improved, perioperative respiratory adverse events occur in up to 50% of children with at least one risk factor.

“A variety of approaches are available to optimize anesthetic management and minimize adverse events in high-risk children, including the use of a laryngeal mask and the intravenous induction of anesthesia,” the researchers wrote. “Although the use of beta 2-adrenergic agonists prevents an increase in respiratory resistance during intubation, existing evidence has not demonstrated a reduction of respiratory adverse events in the general populations receiving preoperative inhaled albuterol. Albuterol may, however, be beneficial in higher risk groups, such as children with asthma and related symptoms or a recent respiratory tract infection.”

The study — known as the Reducing Anesthetic Complications in Children Undergoing Tonsillectomies (REACT) with Albuterol trial — included 484 children aged 0 to 8 years who underwent anesthesia for tonsillectomy at Perth Children’s Hospital between July 15, 2014, and May 18, 2017. The children received either two actuations of 100 µg albuterol each or placebo before surgery.

Results showed that perioperative respiratory adverse events occurred more often in children who received placebo (47.9%) compared with those who received albuterol (27.8%). The likelihood of perioperative respiratory adverse events remained significantly higher among children who received placebo, even after adjusting for age, type of airway device and severity of obstructive sleep apnea (OR = 2.8; 95% CI, 1.9-4.2).

According to the researchers, there were significant differences between the placebo and albuterol groups in the prevalence of laryngospasm (11.8% vs. 5%), coughing (33.2% vs. 11.2%) and oxygen desaturation (22.7% vs. 14.9%).

For every five children undergoing adenotonsillectomy who were treated with albuterol, one additional case of respiratory adverse events was prevented (number needed to treat = 4.8; 95% CI, 8.6-3.5), the researchers said. Additionally, no unexpected or serious adverse events were reported.

“Our results demonstrate efficacy and are not sensitive to adjustment for obstructive sleep apnea severity or airway type,” the researchers wrote. “Our low dropout rate also suggested that our intervention is well-tolerated and feasible to implement. We are confident that our results are likely to be generalizable to similar centers.” – by Katherine Bortz

Disclosures: von Ungern-Sternberg reports receiving grants from the Perth Children’s Hospital (PCH) foundation and Australia and New Zealand College of Anaesthetists, and other support from the PCH Foundation during the conduct of the study. Please see the study for all other authors’ relevant financial disclosures.

Children who received albuterol before undergoing tonsillectomy were significantly less likely to experience respiratory adverse events, including laryngospasm and oxygen desaturation, compared with children who received a placebo, according to findings from a randomized clinical trial.

Britta S. von Ungern-Sternberg, MD, PhD, professor in department of emergency medicine within the faculty of health and medical sciences at the University of Western Australia, and colleagues wrote that even though the safety of pediatric anesthesia has improved, perioperative respiratory adverse events occur in up to 50% of children with at least one risk factor.

“A variety of approaches are available to optimize anesthetic management and minimize adverse events in high-risk children, including the use of a laryngeal mask and the intravenous induction of anesthesia,” the researchers wrote. “Although the use of beta 2-adrenergic agonists prevents an increase in respiratory resistance during intubation, existing evidence has not demonstrated a reduction of respiratory adverse events in the general populations receiving preoperative inhaled albuterol. Albuterol may, however, be beneficial in higher risk groups, such as children with asthma and related symptoms or a recent respiratory tract infection.”

The study — known as the Reducing Anesthetic Complications in Children Undergoing Tonsillectomies (REACT) with Albuterol trial — included 484 children aged 0 to 8 years who underwent anesthesia for tonsillectomy at Perth Children’s Hospital between July 15, 2014, and May 18, 2017. The children received either two actuations of 100 µg albuterol each or placebo before surgery.

Results showed that perioperative respiratory adverse events occurred more often in children who received placebo (47.9%) compared with those who received albuterol (27.8%). The likelihood of perioperative respiratory adverse events remained significantly higher among children who received placebo, even after adjusting for age, type of airway device and severity of obstructive sleep apnea (OR = 2.8; 95% CI, 1.9-4.2).

According to the researchers, there were significant differences between the placebo and albuterol groups in the prevalence of laryngospasm (11.8% vs. 5%), coughing (33.2% vs. 11.2%) and oxygen desaturation (22.7% vs. 14.9%).

For every five children undergoing adenotonsillectomy who were treated with albuterol, one additional case of respiratory adverse events was prevented (number needed to treat = 4.8; 95% CI, 8.6-3.5), the researchers said. Additionally, no unexpected or serious adverse events were reported.

“Our results demonstrate efficacy and are not sensitive to adjustment for obstructive sleep apnea severity or airway type,” the researchers wrote. “Our low dropout rate also suggested that our intervention is well-tolerated and feasible to implement. We are confident that our results are likely to be generalizable to similar centers.” – by Katherine Bortz

Disclosures: von Ungern-Sternberg reports receiving grants from the Perth Children’s Hospital (PCH) foundation and Australia and New Zealand College of Anaesthetists, and other support from the PCH Foundation during the conduct of the study. Please see the study for all other authors’ relevant financial disclosures.