Albuterol before tonsillectomy prevents postoperative respiratory complications: JAMA

Australia: Administration of albuterol before tonsillectomy may help in the prevention of perioperative respiratory adverse events in children laryngospasm, coughing and oxygen desaturation compared with children who received a placebo. The findings of the recent study have been published in the journal JAMA Pediatrics.

Based on the study, the authors suggest that premedication with albuterol should be considered for children undergoing tonsillectomy.

Tonsillectomy is a common procedure performed in children for the treatment of chronic tonsillitis and obstructive sleep apnea. Up to half of the children having this procedure experience a perioperative respiratory adverse event. Britta S. von Ungern-Sternberg, Department of Anaesthesia and Pain Management, Perth Children’s Hospital, Perth, Australia, and colleagues conducted the study to determine whether inhaled albuterol sulfate (salbutamol sulfate) premedication decreases the risk of perioperative respiratory adverse events in children undergoing anaesthesia for tonsillectomy.

For the purpose, about 480 children aged 8 years or younger undergoing tonsillectomy under general anesthesia were randomized to receive inhaled albuterol or placebo roughly 20 minutes before surgery. Children with the cardiopulmonary disease were excluded.

The primary outcome — the incidence of perioperative adverse respiratory events — occurred significantly less often with albuterol than with placebo (28% vs. 48% of children). In particular, the reduction was significant for laryngospasm, coughing, and oxygen desaturation. Adjustment for the severity of obstructive sleep apnea (OSA) did not decrease the observed benefits.

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Key findings of the study include:

• Perioperative respiratory adverse events occurred in 67 of 241 children (27.8%) receiving albuterol and 114 of 238 children (47.9%) receiving a placebo.


• After adjusting for age, type of airway device, and severity of obstructive sleep apnea in a binary logistic regression model, the likelihood of perioperative respiratory adverse events remained significantly higher in the placebo group compared with the albuterol group.


• Significant differences were seen in children receiving placebo vs albuterol in laryngospasm (28 [11.8%] vs 12 [5.0%], coughing (79 [33.2%] vs 27 [11.2%]), and oxygen desaturation (54 [22.7%] vs 36 [14.9%]).

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"Albuterol premedication administered before tonsillectomy under general anesthesia in young children resulted in a clinically significant reduction in rates of perioperative respiratory adverse events compared with the rates in children who received placebo," concluded the authors.

For detailed study log on to doi:10.1001/jamapediatrics.2019.0788