Pediatric tonsillectomy: premedication with albuterol linked to reduced AEs

  • von Ungern-Sternberg BS & al.
  • JAMA Pediatr
  • 22 Apr 2019

  • International Clinical Digest
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  • 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. 

Key results

  • 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.

Study design

  • 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.

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