What is the anesthetic management for adenoidectomy?

From the Guidelines

Adenoidectomy should be performed under general anesthesia with a laryngeal mask airway (LMA) as the preferred airway management technique to minimize perioperative respiratory adverse events. The anesthetic management of adenoidectomy begins with a preoperative assessment focusing on airway evaluation and identification of any comorbidities 1. Standard monitoring includes ECG, pulse oximetry, capnography, and non-invasive blood pressure. Induction can be achieved with propofol (2-3 mg/kg), followed by a muscle relaxant such as rocuronium (0.6 mg/kg) or atracurium (0.5 mg/kg) to facilitate airway management. Maintenance is typically with sevoflurane or desflurane in an oxygen and air mixture. Opioids like fentanyl (1-2 mcg/kg) or remifentanil infusion (0.05-0.2 mcg/kg/min) provide analgesia. Some key points to consider in the anesthetic management of adenoidectomy include:

• The use of a LMA is preferred over an endotracheal tube (ETT) due to a lower incidence of coughing, stridor, and laryngospasm 1
• The cricoid pressure maneuver during rapid sequence induction should be avoided to decrease the incidence of respiratory complications 1
• Dexamethasone (0.15-0.5 mg/kg, maximum 10 mg) should be administered early to reduce postoperative pain, nausea, and airway edema
• Antiemetics such as ondansetron (0.1 mg/kg) are recommended to prevent postoperative nausea and vomiting
• Prior to extubation, the oropharynx should be suctioned thoroughly, and extubation should occur when the patient is fully awake with intact protective reflexes to minimize the risk of airway complications from residual bleeding. Postoperative monitoring focuses on respiratory status, bleeding, and pain management, typically using acetaminophen and NSAIDs as first-line agents.

From the Research

Anaesthetic Management for Adenoidectomy

• The anaesthetic management for adenoidectomy involves the use of various drugs and techniques to ensure a smooth and pain-free procedure 2, 3.
• A study published in 2011 found that the combination of i.v. ketoprofen and i.v. paracetamol provides superior postoperative analgesia in children undergoing adenoidectomy compared to either drug alone 2.
• The same study found that the combination group required significantly less supplementary rescue analgesia than children in the ketoprofen and paracetamol groups 2.
• Another study published in 1999 compared the induction and recovery characteristics of sevoflurane anesthesia induced with either propofol or sevoflurane in pediatric outpatients undergoing adenoidectomy 3.
• The study found that induction of sevoflurane anesthesia with propofol resulted in longer, but more calm, early recovery, but did not delay discharge or affect recovery at home 3.

Surgical Techniques and Postoperative Care

• Adenoidectomy can be performed using various techniques, including conventional curettage adenoidectomy and endoscopic microdebrider adenoidectomy 4.
• A study published in 2025 found that endoscopic powered adenoidectomy performed better in terms of completion of resection, accuracy of resection under vision, collateral damage, and post-operative pain 4.
• The study also found that conventional curettage adenoidectomy scored higher in terms of shorter surgery times and less intraoperative hemorrhage 4.
• Postoperative care for adenoidectomy patients involves managing pain and preventing complications, such as bleeding and infection 2, 4.

Indications and Risks

• Adenoidectomy is commonly performed in children with recurrent upper respiratory infections, otitis media with effusion, and obstructive sleep apnea syndrome 5.
• The procedure carries some risks, including bleeding, infection, and emotional distress for the patient and family 5.
• Non-surgical treatments, such as intranasal steroids, may also be used to treat adenoid hypertrophy 5.
• Clinical guidelines for adenoids and adenoidectomy have been developed to provide a framework for diagnosis, treatment, and management of adenoid-related disorders 6.