According to the results of the Reducing Anesthetic Complications in Children Undergoing Tonsillectomies (REACT) trial, young children who received inhaled albuterol sulfate prior to receiving anesthesia for tonsillectomy had decreased rates of perioperative respiratory adverse events compared with those who received placebo.

The randomized, triple-blind, placebo-controlled study was conducted between July 15, 2014 and May 18, 2017 and included a total of 484 children 0 to 8 years old who received 2 actuations of albuterol (200μg total) or placebo prior to undergoing anesthesia for tonsillectomy. The main outcome of the study was the rate of respiratory adverse events (bronchospasm, laryngospasm, obstruction of the airway, desaturation, coughing, and stridor) that occurred perioperatively until discharge from the postanesthesia care unit.

The intention-to-treat analysis included a total of 479 data sets. The median (range) age of the children included in the study was 5.6 (1.6, 8.9) and 58.9% (N=285) were boys. The study authors reported that 27.8% (67/241) of children who received albuterol experienced a perioperative respiratory adverse event compared with 47.9% (114/238) of children who received placebo. Additionally, the likelihood of perioperative respiratory adverse events was found to be significantly higher in children who received placebo compared with those who received albuterol after adjustments for age, airway device type, and severity of obstructive sleep apnea (OSA) were made in a binary logistic regression model (odds ratio [OR] 2.8; 95% CI, 1.9-4.2; P <.001).

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“Significant differences were seen in children receiving placebo vs albuterol in laryngospasm (28 [11.8%] vs 12 [5.0%]; P =.009), coughing (79 [33.2%] vs 27 [11.2%]; P <.001), and oxygen desaturation (54 [22.7%] vs 36 [14.9%]; P =.03),” the study authors also reported. They added, “For every 5 children undergoing adenotonsillectomy treated with albuterol, 1 additional case of respiratory adverse events was prevented (NTT [number needed to treat], 4.8; 95% CI, 8.6-3.5).”

According to the findings of this trial, premedication with albuterol prior to undergoing anesthesia for tonsillectomy significantly reduced perioperative respiratory adverse events. Based on this data, the authors suggest that, “anesthetists should consider the use of albuterol in routine practice, particularly in children with moderate to severe OSA.”

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