BackgroundTonsillectomy with or without adenoidectomy (AT/T) is among the most common pediatric surgical procedures performed in the United States, but its outcomes in children with cleft palate are poorly characterized, with no consensus in the literature on risk profile. This scoping review examines and synthesizes the available evidence on functional outcomes and postoperative complications following AT/T in this population.MethodsPubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases were searched, and study selection was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews guidelines. Peer-reviewed articles reporting postoperative outcomes of AT/T in patients under 18-years-old with a history of cleft palate repair, performed either before or concurrently with AT/T, were included. Outcomes characterized included those relating to sleep-disordered breathing, hearing loss, perceptual speech characteristics, and velopharyngeal competency.ResultsOf 672 unique studies identified, 16 studies met the criteria for inclusion. Postoperative trends identified included improvements in sleep-disordered breathing (6 of 9 [66.7%] studies), generally stable or enhanced speech outcomes, and low rates of postoperative velopharyngeal insufficiency. Some evidence indicates that AT/T may provide benefit in reducing conductive hearing loss in this population. Surgical complication rates were reported infrequently and were highly variable among studies.ConclusionsFindings suggest that AT/T does not demonstrate a high risk of adverse postoperative outcomes and may provide benefit in pediatric patients with cleft palate. However, the available evidence is limited, and outcomes appear less predictable than in the general pediatric population, underscoring the necessity of thorough individualized assessment when making surgical decisions in children with cleft palate.

Background/Objectives: Emergence delirium (ED) is common after sevoflurane anesthesia in children undergoing otolaryngologic surgery. Remimazolam is an ultra-short-acting benzodiazepine that may reduce ED without delaying recovery. This study evaluated the effect of a single remimazolam bolus administered at the end of surgery on ED in children undergoing tonsillectomy and/or adenoidectomy. Methods: In this prospective, randomized, triple-blind, placebo-controlled trial, 110 children aged 3-9 years with American Society of Anesthesiologists physical status I received remimazolam 0.1 mg/kg (n = 57) or an equal volume of normal saline (n = 53) immediately after discontinuation of sevoflurane and before extubation. The primary outcome was ED at extubation, defined as a Pediatric Anesthesia Emergence Delirium (PAED) score ≥ 10. Secondary outcomes included Face, Legs, Activity, Cry, and Consolability (FLACC) scores, emergence time, early recovery, postoperative vomiting, and airway complications. Results: ED occurred in 1 of 57 children (1.8%) receiving remimazolam and in 11 of 53 children (20.8%) receiving placebo (p = 0.002). The absolute risk reduction was 19.0% (95% confidence interval [CI], 7.5-31.8), the relative risk was 0.08 (95% CI, 0.01-0.63), and the number needed to treat was 6. The overall distribution of FLACC scores at extubation differed between groups (p = 0.047), with FLACC scores of 0 occurring more frequently in the remimazolam group. Median emergence time was 10 min in both groups, and all children achieved a modified Aldrete score > 8 within 15 min. Postoperative vomiting was assessed through 30 min; the comparison at 5 min showed no significant between-group difference. Airway complications also did not differ significantly between groups. Conclusions: A single intravenous bolus of remimazolam 0.1 mg/kg administered at the end of surgery significantly reduced PAED-defined ED without prolonging emergence or delaying early postoperative recovery.

Background: Large prospective studies on the prevalence of acute and persistent pain in children are limited, and risk factors associated with post-surgical pain in children remain unclear. Objective: To examine the incidence of pediatric acute (APOP) and persistent postoperative pain (PPOP) and to determine whether factors such as age, sex, preoperative anxiety/sleep disturbance, preoperative pain and parental stress are associated with increased risk. Design: Prospective observational multicenter study. Setting: Hospitals performing pediatric surgery in southern Sweden. Patients: 601 children aged 1-17 years planned for one of the European Society of Pediatric Anesthesia (ESPA) pre-defined surgical procedures: inguinal hernia, circumcision/hypospadias/retentio testis, adenoidectomy/tonsillectomy/tonsillotomy, appendectomy and orthopedic acute fracture surgery. Main outcome measures: Postoperative pain in PACU after 24 h and 3, 6 and 12 months, level and description of the pain and effect on the child. Results: The incidence of APOP in the postoperative care unit was 0-27%, increasing to 13-58% after 24 h depending on surgery type. The incidences of PPOP were 4-24%, 4-30%, and 0-19% at 3, 6, and 12 months, respectively, depending on surgery type. Older age was a risk factor for APOPPACU (OR 1.2, p < 0.001) and APOP24h (OR 1.3, p < 0.001), whereas female sex was a risk factor only for PPOP6months (OR 2.1, p = 0.028). Self-reported parental stress was a significant risk factor for postoperative pain at all follow-ups, exhibiting increasing influence (APOP24h OR 1.2, p = 0.001; 3months OR 1.5, p < 0.001; 6months OR 1.3, p < 0.001; 12months OR 1.5, p < 0.001). Preoperative anxiety/sleep disturbance only affected APOPPACU (OR 2.0, p = 0.008), whereas preoperative pain was not a risk factor. Conclusions: The incidences of APOP and PPOP were lower than in previous studies. Possible risk factors for acute pain include older age and preoperative anxiety/sleep disturbance. Only self-reported parental stress was a consistent risk factor for persistent pain.