Factors Influencing Postanesthesia Recovery After Pediatric Ambulatory Tonsillectomy and Adenoidectomy

To the Editor: We welcome the perceptive study by Edler et al. (1) who present some potentially useful findings. However, because pain after tonsillectomy and adenoidectomy is known to be considerable (2) and a common cause of prolonged length of stay (3,4), we were surprised that no data regarding pain were included. We believe the model would appear vastly different had this been included, and suspect that the model's predictive value is severely limited by this absence. The leading cause of prolonged length of stay and unplanned admissions is postoperative nausea and vomiting (3,5,6), a well-known complication of tonsillectomy and adenoidectomy (7). The combination of ondansetron and dexamethasone has recently been shown to be more effective in preventing postoperative nausea and vomiting than is a single agent (8,9). It is unclear therefore why the authors enrolled their subjects in a second study allowing them only a single antiemetic agent, which would clearly influence results regarding length of stay. Despite these reservations, we encourage further population-based studies of this nature to elucidate both best clinical practice and more cost-effective management plans. Mary H. Lane, FRCA Fidelma Flynn, FCARCSI Lucy H. Hepburn, FRCA Sian Jaggar, FRCA Department of Anaesthesia Royal Brompton Hospital London, UK [email protected]