Severe OSA, tonsillectomy (adult)

41 yo for tonsillectomy

Background

Severe OSA, AHI 107, normally on CPAP

Morbid obesity – 56

IDDM – new diagnosis after recent presentation with Hyperglycaemic hyperosmolar syndrome (HHS) requiring ICU

Issues and discussion

  • ICU post-operatively?

Mixed central and obstructive sleep apnoea – higher risk as per literature and respiratory discussion.

Tonsillectomy in adults is painful. Opioids often required

  • Patient had ICU bed booked in clinic by a senior consultant. Surgeon had indicated that ICU bed not required.
  • Surgeon of the opinion that patients are usually much better post-operatively
  • CPAP post airway surgery – usually ok post tonsils. Not post sinus surgery.
  • Surgical preference on RFA is always helpful and if we are deviating from that it is helpful to communicate with surgeon. Note ICU beds are in demand at JHH, and patient may be cancelled or list delayed if no ICU bed available. 
  • Children post-tonsillectomy often go to PICU. Evidence is growing to show that this is unnecessary, regardless of AHI