Management of children with Cor Pulmonale secondary to hypertrophy of adenoids/tonsils in limited resource setting

Abstract

Background: In pediatrics, cor pulmonale due to adenoidal and tonsillar hypertrophy is uncommon. The major mode of management is adenoidectomy with or without tonsillectomy, however in a limited resource setting, managing the few cases diagnosed can be difficult. Objectives: This study aimed to evaluate the perioperative management and outcomes among patients with cor pulmonale secondary to adenotonsillar hypertrophy at CHUK. Patients and method: The study is observational prospective and descriptive. It was conducted at CHUK from September 2019 to August 2021. It includes patients with cor pulmonale secondary to adenoids/tonsils hypertrophy who underwent surgery at UTHK. Perioperative management and outcomes were recorded. Results: In this study, 32 patients were enrolled of which 87.5% were males with ages ranging from 9 months to 5 years. Among the participants, 21 had cor Pulmonale of which 66% started treatment of cor pulmonale before surgery. The median preoperative oxygen saturation in this study was 95% ranging from 65% to 99% on room air. Consideration anesthesia medications, 100% of patients were induced on halothane with oxygen, 1 to 2 mcg/kg of fentanyl, 2-3mg/kg of Propofol before the intubation. analgesia was Fentanly100 %, paracetamol75 %, diclofenac 60%. Postoperatively, 29 patients(91%) were extubated immediately after surgery of which 4 had respiratory failure, 2 had pulmonary edema; 3 patients were kept intubated after surgery. 7 patients continued oxygenotherapy, additional 5 patients were managed by Lasix postoperatively. 81.3% of patients were admitted and monitored in the general ward; 4 needed HDU. 1 patient extubated himself while he was being transported to PICU and he was observed in HDU. Only 2 patients were admitted to PICU, no death was encountered. Conclusion: Patients with cor pulmonale secondary to adenotonsillar hypertrophy can be safely managed by adenoidectomy/tonsillectomy and monitored intensively in the general ward or HDU. Good preoperative preparation and assessment plus better anesthesia consideration intraoperatively improves outcome and reduces the need for a PICU bed.