Background: Tonsillectomy, with or without adenoidectomy, is the most commonly performed surgical procedure among pediatric population in the United States. Tonsillectomy is a surgical procedure of the complete removal of the tonsils and its capsule and often accompanied by removal of adenoids in the presence of sleep disorder breathing.
Problem statement: Oral secretions and blood in the oropharynx can cause local irritation or aspiration in patients, who are recovering from anesthesia following adenotonsillectomy (AT) surgery. Gravity plays a significant role in the mobilization of oral and nasal fluids into the lower respiratory tract. Usually, excessive airway secretions among pediatric patient may lead to hypoxemia, hypercarbia, airway …show more content…
Children are more susceptible to postoperative airway complication, during the period of extubation, to post anesthesia recovery phase. AT surgery combined with anesthetic implications on swallowing reflex and blood and secretions in the airway places the children at higher risk for adverse airway events during the postoperative period. Any airway complications, regardless of the severity, can lead to morbidity and mortality among children. The airway is the most critical safety issue among children, and any adverse events can result in prolonged recovery time or even inpatient hospitalization. The anesthesia provider and PACU personnel carry a high level of vigilance to minimize airway complication among postoperative children. Anxiety is one of the most challenging aspects of pediatric surgical patients, and apart from behavioral and psychological therapy, midazolam plays an enormous role during the preoperative period. Apparently, midazolam sedation impairs the swallowing reflex under therapeutic doses.10 The cerebral centers have some degree of voluntary control over the laryngeal reflexes during conscious state, resulting in regaining control of respiration after a potential aspiration episode.11 Sedation can cause altered pharyngeal functioning and altered swallowing breathing coordination, leading to an increased risk for aspiration. Midazolam causes a decrease in the frequency of spontaneous swallowing.10 Propofol also proven to cause swallowing impairment during sedation.9 The duration of swallowing impairment related to propofol is unknown. AT surgical children are prone to airway complications during immediate postoperative period.6,8,13,15,16 Pain is an inevitable natural component of any surgery, and pain medications have a significant role during the postoperative period. Premedication with midazolam and pain medications in postoperative period impairs the pharyngeal function and