P053: FACTORS INFLUENCING PREOPERATIVE SEDATION CHOICE AND OUTCOMES IN PEDIATRIC TONSILLECTOMY AND ADENOIDECTOMY SURGERY
Samantha Gibson1; Stephany Bustamante1; Ajay Patel, MD2; Adalberto Torres2
1University of Central Florida College of Medicine; 2Nemours Children's Hospital Florida
Intro: Many pediatric patients experience anxiety before surgery and are given a preoperative sedative, typically midazolam or dexmedetomidine (dex), to ease anxiety and facilitate smoother anesthesia induction. Midazolam, a benzodiazepine, provides sedation, anxiolysis, and anterograde amnesia but can cause agitation and respiratory depression.1 Dex, an α2-adrenoceptor agonist, offers sedation, analgesia, and minimal respiratory depression but can depress the sympathetic nervous system.2 A Chinese randomized controlled trial found that in pediatric patients, midazolam is associated with postoperative behavioral changes and respiratory depression, whereas dex can cause hypotension and bradycardia.3 However, limited research explores factors influencing medication choice.
This study aimed to determine whether age, sex, and weight influence preoperative sedation selection in pediatric tonsillectomy and adenoidectomy (T&A) patients across Nemours Children’s Hospital in Delaware and Florida (NCH-DE and NCH-FL). Additionally, the study examined the relationship between these variables, premedication choice, postoperative adverse effects, and post-anesthesia care unit (PACU) length of stay (LOS).
Methods: This retrospective study analyzed electronic medical records of children who underwent T&A at NCH-DE and NCH-FL from 2018 – 2023. Patients were excluded if older than 18 at time of surgery or if with preexisting pulmonary, cardiovascular, hepatic, or neurological conditions. Data was collected via RedCap. Variables included date of birth, procedure date, age, sex, weight, premedication type and dosage, allergies, PACU LOS, and adverse effects (e.g., irritability, dizziness, nausea, headache, blurred vision, and vomiting).
Descriptive statistics summarized patient characteristics. Pearson’s chi-square test assessed associations between preoperative medication and adverse effects. Multiple linear regression analyzed age, sex, weight, premedication, adverse effects, and institution on PACU LOS. Multiple logistic regression evaluated associations between age, sex, weight, premedication, and adverse effects. Multinomial logit regression analyzed how age, gender, and weight influence premedication choice.
Results: A total of 516 patient charts were reviewed; 366 were excluded due to preexisting conditions. The final dataset included 150 charts.
Age, sex, and weight were not significantly associated with preoperative medication choice.
LOS significantly decreased (p = 0.02) with increased age. LOS significantly increased (p < 0.01) when patients experienced an adverse effect. There was no statistically significant relationship between sex, weight, or preoperative medication choice on LOS.
After adjusting for covariates, increased age was associated with lower odds of adverse effects (OR = 0.959, 95% CI [0.936–0.982], p < 0.01). Increased weight was associated with increased odds of adverse effects (OR = 1.069, 95% CI [1.029–1.111], p < 0.01). There was no significant association between preoperative medicine use or sex and the risk of adverse effects.
Discussion: Premedication selection could be dependent on provider preference, as patient demographics did not significantly influence it. Reasonably, adverse effects prolonged PACU LOS. Older patients experienced shorter LOS, possibly due to better cooperation and comprehension. They also experienced fewer postoperative adverse effects, suggesting improved tolerance with age. Increased weight correlated with more adverse effects, potentially due to midazolam’s pharmacokinetics. Future work should explore weight as a confounder.
Conclusion: Premedication choice in pediatric T&A patients was not significantly influenced by age, sex, or weight.
