- For high-risk children undergoing tonsillectomy, albuterol premedication before general anesthesia is linked to reduced perioperative adverse event (AE) rates vs placebo.
- Triple-blind, randomized trial opens window on risk reduction option.
- Authors urge consideration of albuterol premedication in this population.
Why this matters
- Many children undergo tonsillectomy, and an array of management choices exist to minimize AEs in high-risk patients.
- Authors note contrast of their findings with earlier reports in more general pediatric populations that found no benefit with albuterol, but those did not involve airway-related surgeries.
- AE rates:
- 27.8% with albuterol vs 47.9% with placebo.
- For AE risk with placebo vs albuterol: aOR, 2.8 (95% CI, 1.9-4.2; P<.001>
- Specific difference with placebo vs albuterol in:
- Laryngospasm: 11.8% vs 5.0% (P=.009).
- Coughing: 33.2% vs 11.2% (P<.001>
- Oxygen desaturation: 22.7% vs 14.9% (P=.03).
- Number needed to treat to prevent 1 respiratory AE: 5.
- The Reducing Anesthetic Complications in Children Undergoing Tonsillectomies (REACT) trial, triple-blind, randomized study in an Australian tertiary pediatric hospital, July 2014-May 2017.
- 484 children, ages 0-8 years, having tonsillectomy with anesthesia.
- Outcome: perioperative respiratory AEs.
- Funding: PCH Foundation; ANZCA project grant.
- Single-center, Australian, so generalizability unclear.