Inpatient and Outpatient Specialty Care Clinical Pathway to Triage Tonsillectomy and/or Adenotonsillectomy Patients with or without Preoperative Polysomnography
Consider Sleep Study for Patients at Risk for Complications Intra/Postoperatively
- Down syndrome
- Craniofacial anomalies
- Neuromuscular disease (incl. cerebral palsy)
- Chronic lung disease
- Sickle cell disease
- Metabolic disease
- BMI ≥ 95th percentile
ENT Office Visit
- History & Physical
- Review Polysomnography Results (if applicable)
- Assessment by Anesthesia Resource Center (ARC)
- Review:
- Ambulatory Surgery Centers (ASCs)
Patient Selection — View Policy (05.13.01)
and Job Aid
Ambulatory Surgery Center
CHOP Day Surgery
CHOP Inpatient
Post-surgery/Perianesthesia Care Unit
If patient needs unplanned admission admit to PICU or Inpatient Surgical Unit
PICU
Inpatient Surgical Unit
Ambulatory Surgical Center (ASC) | CHOP Day Surgery | CHOP Inpatient | |
---|---|---|---|
Age | ≥ 3 1/2 y/o Comorbid conditions cleared by Anesthesia |
> 3 y/o No comorbid conditions |
All patients < 3 y/o OR > 3 y/o with comorbid conditions |
Weight | Review ASC Patient Selection — View Policy (05.13.01) and Job Aid |
Review ASC Patient Selection — View Policy (05.13.01) and Job Aid |
BMI ≥ 35 |
Polysomnography Results (if applicable) | AHI 0-23 and No high-risk gas exchange concerns Peak CO2 ≤ 55, O2 nadir ≥ 90 85-89% with approval from ASC medical director |
AHI 0-23 and No high-risk gas exchange concerns Peak CO2 ≤ 60, O2 nadir ≥ 85 |
AHI > 23 and High-risk gas exchange concerns Peak CO2 ≥ 60, O2 nadir ≤ 85 |
Bed Request | None | None | PICU or Inpatient Surgical Unit |
Posted: July 2016
Revised: May 2020
Authors: L. Elden, MD; T. Giordano, DNP; J. Galvez, MD; D. Davis, MD; E. Phillips, RN; D. Toner, CRNP; C. Petro, BSN; A. Williams, CRNP
Revised: May 2020
Authors: L. Elden, MD; T. Giordano, DNP; J. Galvez, MD; D. Davis, MD; E. Phillips, RN; D. Toner, CRNP; C. Petro, BSN; A. Williams, CRNP
Evidence
- Clinical Practice Guideline: Tonsillectomy in Children (Update)
- Risk assessment for respiratory complications in paediatric anesthesia: a prospective cohort study
- Predictors of Perioperative Complications in Higher Risk Children after Adenotonsillectomy for Obstructive Sleep Apnea: A Prospective Study
- Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
- Clinical Practice Guideline: Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children