None listed
Conditions
Brief summary
Removal of the tracheal tube can be performed while children are still deeply anesthetized or when they are awake. Each technique has its own advantages and disadvantages. In healthy children, it has been shown that there are no clinical differences between extubation in the awake state vs anesthetized state. In patients with a high risk of developing a postoperative respiratory complication such as those with asthma, it may be preferable to remove the tracheal tube while the patients are still anesthetized to avoid airway stimulation and consecutively bucking, coughing and bronchospasm. The results of a recent large prospective cohort study at our institution with over 9000 children allow to identify children with a high risk for developping postoperative respiratory complications. The aim of this present randomized controlled trial is to assess whether children at a high risk for respiratory problems benefit from anethetized extubation as compared to awake extubation following adeno-/tonsillectomy. We hypothesize that children with a high risk for respiratory problems defined by the presence of either airway susceptibility, eczema or a positive family history will demonstrate less respiratory problems when extubated anaesthetised compared with high risk children who are extubated awake.
Interventions
Group “awake”
The children of group “awake” will be extubated awake following an anaesthetic with sevoflurane. The endotracheal tube will be removed when the children have demonstrated facial grimace, adequate tidal volume and respiratory rate, coughing with open mouths or opening of their eyes and purposeful movements.
Sponsors
Britta von Ungern-Sternberg
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator)
Eligibility
Sex/Gender
All
Age
0 to 16 Years
Healthy volunteers
No
Inclusion criteria
Children, aged 0 to 16 years, male or female with one or more of the following risk factors (I-III) I. Airway susceptibility as defined as 1 or more of the following a. Cold or flu in the last two weeks b. Wheezing > 3 times in the last 12 months c. Wheezing at exercise d. Nocturnal dry cough II. Current or past eczema III. Positive family history as defined as 1 or more of the following a. =2 family members with asthma b. =2 family members with eczema c. =2 family members with hayfever d. Mother or mother and father smoking
Exclusion criteria
Known cardiac disease, airway or thoracic malformations, need for premedication with midazolam, contraindication for deep extubation (e.g. gastrooesophageal reflux).
Outcome results
None listed