• Calvin Lo and Kimmo Murto.
• Department of Anesthesiology, Perioperative Medicine and Pain Management, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada. calvin.lo@saskhealthauthority.ca.
• Can J Anaesth. 2024 Dec 16.

PurposeThis Continuing Professional Development module aims to help the general anesthesiologist recognize common pitfalls in ambulatory pediatric adenotonsillectomy and perform appropriate risk stratification, analgesic management, and disposition planning.Principal FindingsPediatric adenotonsillectomy is a widely performed procedure. An updated approach to preoperative risk assessment of commonly associated comorbidities allows the practitioner to anticipate and plan for adverse events. Risks include obstructive sleep apnea, airway hyperresponsiveness, asthma, recent upper respiratory tract infections, obesity, and young age. Risk-modifying interventions consist of delaying surgery, preoperative bronchodilator therapy, recognizing the limitations of volatile agents, and referral of high-risk patients to specialized pediatric centres. Appropriate selection of intraoperative and postoperative analgesia can optimize patient comfort, avoid readmission, and limit adverse events such as postoperative hemorrhage or respiratory depression.ConclusionsAmbulatory pediatric adenotonsillectomy is a common surgical procedure, performed both in the community as well as tertiary care pediatric centres. To optimize outcomes in this heterogenous patient population, anesthesiologists must risk stratify and anticipate perioperative respiratory adverse events.© 2024. Canadian Anesthesiologists' Society.

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