Anästhesie für HNO-Eingriffe bei Kindern

Zusammenfassung

HNO-Eingriffe sind die häufigsten Operationen im Kindesalter – eine optimale anästhesiologische Betreuung sorgt für einen komplikationslosen, sicheren perioperativen Ablauf mit so wenig Dyskomfort für das Kind wie nur möglich. Risikopatienten müssen bereits präoperativ identifiziert werden: die Kombination von atemwegsnahem Eingriff, hyperreagiblem Bronchialsystem sowie Alter unter 3 Jahren kann die Rate an perioperativen respiratorischen Komplikationen erhöhen. Postoperativ gilt es, Komplikationen wie Schmerz und PONV durch engagierte Präventions- und Behandlungsstrategien zu verhindern, sowie respiratorische oder Blutungs-Komplikationen schnell zu erkennen und kompetent zu behandeln. Interdisziplinäre Leitlinien und Absprachen sowie die Gesamtkompetenz des Teams haben das Potenzial, die Sicherheit und das Outcome der Kinder entscheidend zu beeinflussen.

Abstract

Pediatric Anesthesia in Ear Nose Throat (ENT) Surgery

ENT procedures are the most common surgeries in children – an optimal anesthetic management provides an uncomplicated, safe perioperative process with as little discomfort for the child as possible. Children at risk must already be identified preoperatively: the combination of ENT surgery, airway susceptibility and age below 3 years can increase the rate of perioperative respiratory adverse events. Postoperatively, it is important to prevent complications such as pain and PONV by dedicated prevention and treatment strategies, as well as to recognize and treat respiratory or circulatory complications competent. Interdisciplinary guidelines and agreements as well as the overall competence of the team have the potential to improve patient safety and outcome in children.

Schlüsselwörter

Kinderanästhesie - Tonsillektomie - perioperative Komplika­tionen - obstruktive Schlafapnoe - Schmerztherapie

Key words

pediatric anesthesia - tonsillectomy - perioperative adverse events - obstructive sleep apnoea - pain therapy

• Literatur

• 1 Statistisches Bundesamt Gesundheit. Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik) Operationen und Prozeduren der vollstationären Patientinnen und Patienten in Krankenhäusern 2011. Wiesbaden, 25.10.2012. Artikelnummer: 5231401117014
• 2 Scheuber K, Becke K. Ambulante Anästhesie im Kindesalter. Anästhesiol Intensivmed Notfallmed Schmerzther 2013; 48: 92-98
• 3 Faktencheck Gesundheit 2013, Daten Statistisches Bundesamt, Berechnung und Darstellung IGES. Bertelsmann Stiftung, Gütersloh 2012
• 4 Becke K, Giest J, Strauß J. Handlungsempfehlungen zur präoperativen Diagnostik, Impfabstand und Nüchternheit im Kindesalter. Anästh Intensivmed 2007; 48: S62-S66
• 5 Munro J, Booth A, Nicholl J. Routine preoperative testing: a systematic review of the evidence. Health Technol Assess 1997; 1: 1-62
• 6 Meneghini L, Zadra N, Zanette G, Baiocchi M, Giusti F. The usefulness of routine preoperative laboratory tests for one-day surgery in healthy children. Paediatr Anaesth 1998; 8: 1-5
• 7 García-Miguel FJ, Serrano-Aguilar PG, López-Bastida J. Preoperative assessment. Lancet 2003; 362: 1749-1757
• 8 Feely MA, Collins CS, Daniels PR, Kebede EB, Jatoi A, Mauck KF. Preoperative testing before noncardiac surgery: guidelines and recommendations. Am Fam Physician 2013; 87: 414-418
• 9 Gemeinsame Empfehlung der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, Deutschen Gesellschaft für Innere Medizin, Deutschen Gesellschaft für Chirurgie . Präoperative Evaluation erwachsener Patienten vor elektiven, nicht kardiochirurgischen Eingriffen. Anästh Intensivmed 2010; 51: S787
• 10 Eisert S, Hovermann M, Bier H, Göbel U. Präoperative Gerinnungsuntersuchungen bei Kindern vor Adenotomie (AT) und Tonsillektomie (TE): Schützen sie vor Blutungskomplikationen?. Klin Pädiatr 2006; 218: 334-339
• 11 Close HL, Kryzer TC, Nowlin JH, Alving BM. Hemostatic assessment of patients before tonsillectomy: a prospective study. Otolaryngol Head Neck Surg 1994; 111: 733-738
• 12 Kleinschmidt S, Fuchs-Buder T, Wilhelm W, Seyfert UT, Mörsdorf S. Die perioperative Therapie des Von-Willebrand-Syndroms. Anaesthesist 2002; 51: 825-834
• 13 Bundesärztekammer. Querschnitts-Leitlinien (BÄK) zur Therapie mit Blutkomponenten und Plasmaderivaten. 4. Auflage 2008
• 14 Lillicrap D, Nair SC, Srivastava A, Rodeghiero F, Pabinger I, Federici AB. Laboratory issues in bleeding disorders. Haemophilia 2006; 12: S68-S75
• 15 Koscielny J, Ziemer S, Radtke H, Schmutzler M, Sinha P, Salama A, Kiesewetter H, Latza R. A practical concept for preoperative identification of patients with impaired primary hemostasis. Clin Appl Thromb Hemost 2004; 10: 195-204
• 16 Asaf T, Reuveni H, Yermiahu T, Leiberman A, Gurman G, Porat A, Schlaeffer P, Shifra S, Kapelushnik J. The need for routine preoperative coagulation screening tests (prothrombin time PT/partial thromboplastin time PTT) for healthy children undergoing elective tonsillectomy and/or adenoidectomy. Int J Pediatr Otorhinolaryngol 2001; 61: 217-222
• 17 Howells 2nd RC, Wax MK, Ramadan HH. Value of preoperative prothrombin time/partial thromboplastin time as a predictor of postoperative hemorrhage in pediatric patients undergoing tonsillectomy. Otolaryngol Head Neck Surg 1997; 117: 628-632
• 18 Eberl W, Wendt I, Schroeder HG. Präoperatives Screening auf Gerinnungsstörungen vor Adenotomie und Tonsillektomie. Klin Pädiatr 2005; 217: 20-24
• 19 Weiss DR, Strasser EF, Ringwald J, Zimmermann R, Eckstein R. High resolution multimer analysis and the PFA-100 platelet function analyser can detect von Willebrand disease type 2 A without a pathological ratio of ristocetin cofactor activity and von Willebrand antigen level. Clin Lab 2012; 58: 1203-1209
• 20 Hörmann K. Gemeinsame Stellungnahme zur Notwendigkeit präoperativer Gerinnungsdiagnostik vor Tonsillektomie und Adenotomie bei Kindern. Laryngo-Rhino-Otol 2006; 85: 580-581
• 21 Klinge J, Eberl W, Lischetzki G. Die präoperative aPTT-Verlängerung. Pädiatrische Praxis 2004; 65: 57-66
• 22 Tantisira K, Fuhlbrigge AL, Tonascia J, Van Natta M, Zeiger RS, Strunk RC, Szefler SJ, Weiss ST. Childhood Asthma Management Program Research Group . Bronchodilation and bronchoconstriction: Predictors of future lung function in childhood asthma. J Allergy Clin Immunol 2006; 117: 1264-1271
• 23 Becke K. Anesthesia in children with a cold. Curr Opin Anaesthesiol 2012; 25: 333-339
• 24 von Ungern-Sternberg BS, Boda K, Chambers NA, Rebmann C, Johnson C, Sly PD, Habre W. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet 2010; 376: 773-783
• 25 Parnis SJ, Barker DS, Van Der Walt JH. Clinical predictors of anaesthetic complications in children with respiratory tract infections. Paediatr Anaesth 2001; 11: 29-40
• 26 Malisse M, Habre W. Pediatric anesthesia and upper respiratory tract infections. Rev Med Suisse 2010; 6 380 382-383
• 27 Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J 1997; 16: 735-746
• 28 Schuetz P, Müller B, Christ-Crain M, Stolz D et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev 2012; 9 CD007498
• 29 von Ungern-Sternberg BS, Habre W, Erb TO, Heaney M. Salbutamol premedication in children with a recent respiratory tract infection. Pediatr Anesth 2009; 19: 1064-1069
• 30 Tait AR, Malviya S. Anesthesia for the child with an upper respiratory tract infection: still a dilemma?. Anesth Analg 2005; 100: 59-65
• 31 Gislason T, Benediktsdóttir B. Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence. Chest 1995; 107: 963-966
• 32 Ishman SL. Evidence-based practice: pediatric obstructive sleep apnea. Otolaryngol Clin N Am 2012; 45: 1055-1069
• 33 Schwengel DA, Sterni LM, Tunkel DE, Heitmiller ES. Perioperative management of children with obstructive sleep apnea. Anesth Analg 2009; 109: 60-75
• 34 Chau KW, Ng DK, Kwok CK, Chow PY, Ho JC. Clinical risk factors for obstructive sleep apnoea in children. Singapore Med J 2003; 44: 570-573
• 35 Gross JB, Bachenberg KL, Benumof JL, Caplan RA. American Society of Anesthesiologists Task Force on Perioperative Management . Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 2006; 104: 1081-1093
• 36 Carroll JL, McColley SA, Marcus CL, Curtis S, Loughlin GM. Inability of clinical history to distinguish primary snoring from obstructive sleep apnea syndrome in children. Chest 1995; 108: 610-618
• 37 Stuck B, Windfuhr JP, Genzwürker H, Schroten H, Tenenbaum T. Die Tonsillektomie im Kindesalter. Dtsch Arztebl 2008; 105: 852-860
• 38 Roland P, Rosenfeld R, Brooks L, Friedman NR, Jones J, Kim TW, Kuhar S, Mitchell RB, Seidman MD, Sheldon SH, Jones S, Robertson P. American Academy of Otolaryngology – Head and Neck Surgery Foundation . Clinical practice guideline: polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg 2011; 145: S1-S15
• 39 Hill CA, Litvak A, Canapari C, Cummings B, Collins C, Keamy DG, Ferris TG, Hartnick CJ. A pilot study to identify pre- and peri-operative risk factors for airway complications following adenotonsillectomy for treatment of severe pediatric OSA. Int J Pediatr Otorhinolaryngol 2011; 75: 1385-1390
• 40 Nixon GM, Kermack AS, McGregor CD, Davis GM, Manoukian JJ, Brown KA, Brouillette RT. Sleep and breathing on the first night after adenotonsillectomy for obstructive sleep apnea. Pediatr Pulmonol 2005; 39: 332-338
• 41 Coté CJ, Posner KL, Domino KB. Death or Neurologic Injury After Tonsillectomy in Children with a Focus on Obstructive Sleep Apnea: Houston, We Have a Problem!. Anesth Analg 2013; [Epub ahead of print]
• 42 Brown KA, Laferrière A, Lakheeram I, Moss IR. Recurrent hypoxemia in children is associated with increased analgesic sensitivity to opiates. Anesthesiology 2006; 105: 665-669
• 43 Habre W, McLeod B. Analgesic and respiratory effect of nalbuphine and pethidine for adenotonsillectomy in children with obstructive sleep disorder. Anaesthesia 1997; 52: 1101-1106
• 44 Mitteilung der Ständigen Impfkommission am Robert Koch-Institut (RKI) Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut/Stand: August 2013. Epidemiologisches Bulletin Nr. 34, 26.08.2013
• 45 Hölling H, Schlack R, Kamtsiuris P, Butschalowsky H, Schlaud M, Kuth BM. Die KiGGS-Studie. Bundesweite repräsentative Längs- und Querschnittstudie zur Gesundheit von Kindern und Jugendlichen im Rahmen des Gesundheitsmonitorings am Robert Koch-Institut. Bundesgesundheitsbl 2012; 55: 836-842
• 46 Short JA, van der Walt JH, Zoanetti DC. Immunization and anesthesia – an international survey. Paediatr Anaesth 2006; 16: 514-522
• 47 Siebert JN et al. Influence of anesthesia on immune responses and its effects on vaccination in children: review of evidence. Pediatr Anesth 2007; 17: 410-420
• 48 Strauß JM, Gäbler R, Schmidt J, Mehler J, Giest J. Empfehlungen zur ambulanten Anästhesie bei Neugeborenen, Säuglingen und Kleinkindern. Anästh Intensivmed 2007; 48: S67-S70
• 49 Anlage 1 zum Vertrag nach § 115b SGB V – Katalog, SGB V – Ambulantes Operieren und sonstige stationsersetzende Eingriffe im Krankenhaus. www.kbv.de
• 50 Wienke A. Adenoidectomy also inpatient: comments on the Dessau-Roβlau decision of 24 February 2010. Laryngorhinootologie 2011; 90: 228-229
• 51 Brennan LJ. Modern day-case anaesthesia for children. Br J Anaesth 1999; 83: 91-103
• 52 Windfuhr JP, Hübner R, Sesterhenn K. Kriterien zur stationären Krankenhausbehandlung der Adenotomie. HNO 2003; 51: 622-628
• 53 Spencer DJ, Jones JE. Complications of adenotonsillectomy in patients younger than 3 years. Arch Otolaryngol Head Neck Surg 2012; 138: 335-339
• 54 Blacoe DA, Cunning E, Bell G. Paediatric day-case surgery: an audit of unplanned hospital admission Royal Hospital for Sick Children, Glasgow. Anaesthesia 2008; 63: 610-615
• 55 Empfehlungen der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin e.V. und des Berufsverbandes Deutscher Anästhesisten e.V . Mindestanforderungen an den anästhesiologischen Arbeitsplatz. Anästh Intensivmed 2013; 54: 39-42
• 56 DGAI . e.V., BDA e.V. Entschließungen, Empfehlungen und Vereinbarungen. Perioperatives Nüchterngebot bei operativen Eingriffen. 5. Auflage Aktiv Druck & Verlag GmbH; Ebelsbach: 2011
• 57 Brady M, Kinn S, Ness V, O’Rourke K, Randhawa N, Stuart P. Preoperative fasting for preventing perioperative complications in children. Cochrane Database Syst Rev 2009; CD005285
• 58 Kain ZN, Mayes LC, Wang SM, Caramico LA, Hofstadter MB. Parental presence during induction of anesthesia versus sedative premedication: which intervention is more effective?. Anesthesiology 1998; 89: 1147-1156
• 59 Yip P, Middleton P, Cyna AM, Carlyle AV. Non-pharmacological interventions for assisting the induction of anaesthesia in children. Cochrane Database Syst Rev 2009; CD006447
• 60 Vagnoli L, Caprilli S, Messeri A. Parental presence, clowns or sedative premedication to treat preoperative anxiety in children: what could be the most promising option?. Paediatr Anaesth 2010; 20: 937-943
• 61 Lerman J, Jöhr M. Inhalational anesthesia vs. total intravenous anesthesia (TIVA) for pediatric anesthesia. Paediatr Anaest 2009; 19: 521-534
• 62 Becke K. Narkoseeinleitung bei Kindern. Anästh Intensivmed 2010; 6: 347-360
• 63 Gravningsbråten R, Nicklasson B, Raeder J. Safety of laryngeal mask airway and short-stay practice in office-based adenotonsillectomy. Acta Anaesthesiol Scand 2009; 53: 218-222
• 64 Sierpina DI, Chaudhary H, Walner DL, Villines D, Schneider K, Lowenthal M, Aronov Y. Laryngeal mask airway versus endotracheal tube in pediatric adenotonsillectomy. Laryngoscope 2012; 122: 429-435
• 65 Lalwani K, Richins S, Aliason I, Milczuk H, Fu R. The laryngeal mask airway for pediatric adenotonsillectomy: predictors of failure and complications. Int J Pediatr Otorhinolaryngol 2013; 77: 25-28
• 66 Tweedie DJ, Bajaj Y, Ifeacho SN, Jonas NE, Jephson CG, Cochrane LA, Hartley BE, Albert DM, Wyatt ME. Peri-operative complications after adenotonsillectomy in a UK pediatric tertiary referral centre. Int J Pediatr Otorhinolaryngol 2012; 76: 809-815
• 67 Baugh R, Archer S, Mitchell R, Rosenfeld RM, Amin R, Burns JJ, Darrow DH, Giordano T, Litman RS, Li KK, Mannix ME, Schwartz RH, Setzen G, Wald ER, Wall E, Sandberg G, Patel MM. American Academy of Otolaryngology-Head and Neck Surgery Foundation . Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011; 144: S1-S30
• 68 Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and ad enoidectomy in 15,218 patients. Otolaryngol Head Neck Surg 2006; 132: 281-286
• 69 Windfuhr JP. Serious complications following tonsillectomy: how frequent are they really?. ORL J Otorhinolaryngol Relat Spec 2013; 75: 166-173
• 70 Biarent D, Bingham R, Richmond S, Maconochie I, Wyllie J, Simpson S, Nunez AR, Zideman D. European Resuscitation Council. European Resuscitation Council for resuscitation 2005. Section 6. Paediatric liufe support. Resuscitation 2005; 67: S97-S133
• 71 Weiss M, Henze G, Eich C, Neuhaus D. Intraosseous infusion. An important technique also for paediatric anaesthesia. Anaesthesist 2009; 58: 863-866
• 72 Schmidt J, Strauß JM, Becke K, Giest J, Schmitz B. Handlungsempfehlung zur Rapid-Sequence-Induction im Kindesalter. Anästh Intensivmed 2007; 48: S88-S93
• 73 Diab YA, Wong EC, Luban NL. Massive transfusion in children and neonates. Br J Haematol 2013; 161: 15-26
• 74 Bhananker SM, Ramamoorthy C, Geiduschek JM, Posner KL, Domino KB, Haberkern CM, Campos JS, Morray JP. Anesthesia-related cardiac arrest in children: update from the Pediatric Perioperative Cardiac Arrest Registry. Anesth Analg 2007; 105: 344-350
• 75 Sanders JC, King MA, Mitchell RB, Kelly JP. Perioperative complications of adenotonsillectomy in children with obstructive sleep apnea syndrome. Anesth Analg 2006; 103: 1115-1121
• 76 Schreiner MS, O’Hara I, Markakis D, Politis GD. Do children who experience laryngospasm have an increased risk of upper respiratory tract infection?. Anesthesiology 1996; 85: 475-480
• 77 Mamie C, Habre W, Delhumeau C, Argiroffo CB, Morabia A. Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery. Paediatr Anaesth 2004; 14: 218-224
• 78 Tramèr M, Moore A, McQuay H. Prevention of vomiting after paediatric strabismus surgery: a systematic review using the numbers-needed-to-treat method. Br J Anaesth 1995; 75: 556-561
• 79 Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89: 652-658
• 80 Diez L. Assessing the willingness of parents to pay for reducing postoperative emesis in children. Pharmacoeconomics 1998; 13: 589-595
• 81 Sossai R, Jöhr M, Kistler W, Gerber H, Schärli AF. Postoperative vomiting in children. A persisting unsolved problem. Eur J Ped Surg 1993; 3: 206-208
• 82 Büttner W, Finke W, Hilleke M, Reckert S, Vsianska L, Brambrink A. Entwicklung eines Fremdbeobachtungsbogens zur Beurteilung des postoperativen Schmerzes bei Säuglingen. Anaesthesiol Intensivmed Notfallmed Schmerzther 1998; 33: 353-361
• 83 Antonis JH, Poeze M, Van Heurn LW. Boerhaave’s syndrome in children: a case report and review of the literature. J Pediatr Surg 2006; 41: 1620-1623
• 84 Eberhart LH, Geldner G, Kranke P, Morin AM, Schäuffelen A, Treiber H, Wulf H. The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients. Anesth Analg 2004; 99: 1630-1637
• 85 Rüsch D, Eberhart LH, Wallenborn J, Kranke P. Nausea and vomiting after surgery under general anesthesia – an evidence-based review concerning risk assessment, prevention, and treatment. Dtsch Arztebl Int 2010; 107: 733-741
• 86 Becke K, Kranke P, Weiss M, Kretz FJ. Risikoeinschätzung, Prophylaxe und Therapie von postoperativem Erbrechen im Kindesalter. Anästh Intensivmed 2007; 9: S95-S98
• 87 Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, Zernak C, Danner K, Jokela R, Pocock SJ, Trenkler S, Kredel M, Biedler A, Sessler DI, Roewer N. IMPACT Investigators. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004; 350: 2441-2451
• 88 Czarnetzki C, Elia N, Lysakowski C, Dumont L, Landis BN, Giger R, Dulguerov P, Desmeules J, Tramèr MR. Dexamethason and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial. JAMA 2008; 22: 2621-2630
• 89 Becke K, Kranke P, Weiss M, Kretz FJ, Strauß J. Prophylaxe von postoperativer Übelkeit und Erbrechen im Kindesalter bei Adeno-/Tonsillektomien mit Dexamethason. Stellungnahme des Wissenschaftlichen Arbeitskreises Kinderanästhesie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI). Anästh Intensivmed 2009; 7: 496-497
• 90 Vlajkovic GP, Sindjelic RP. Emergence delirium in children: many questions, few answers. Anesth Analg 2007; 104: 84-91
• 91 Dahmani S, Stany I, Brasher C, Lejeune C, Bruneau B, Wood C, Nivoche Y, Constant I, Murat I. Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth 2010; 104: 216-223
• 92 Kain ZN, Caldwell-Andrews AA, Maranets I, McClain B, Gaal D, Mayes LC, Feng R, Zhang H. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg 2004; 99: 1648-1654
• 93 Watcha MF, Ramirez-Ruiz M, White PF, Jones MB, Lagueruela RG, Terkonda RP. Perioperative effects of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy. Can J Anaesth 1992; 39: 649-654
• 94 Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology 2004; 100: 1138-1145
• 95 Bajwa SA, Costi D, Cyna AM. A comparison of emergence delirium scales following general anesthesia in children. Paediatr Anaesth 2010; 20: 704-711
• 96 Aono J, Ueda W, Mamiya K, Takimoto E, Manabe M. Greater incidence of delirium during recovery from sevoflurane in preschool boys. Anesthesiology 1997; 87: 1298-1300
• 97 Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg 2003; 96: 1625-1630
• 98 Kain ZN, Caldwell-Andrews AA, Maranets I, McClain B, Gaal D, Mayes LC, Feng R, Zhang H. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg 2004; 99: 1648-1654
• 99 Pieters BJ, Penn E, Nicklaus P, Bruegger D, Mehta B, Weatherly R. Emergence delirium and postoperative pain in children undergoing adenotonsillectomy: a comparison of propofol vs. sevoflurane anesthesia. Paediatr Anaesth 2010; 20: 944-950
• 100 Cohen IT, Finkel JC, Hannallah RS, Hummer KA, Patel KM. The effect of fentanyl on the emergence characteristics after desflurane or sevoflurane anesthesia in children. Anesth Analg 2002; 94: 1178-1181
• 101 Fitzgerald M, Beggs S. The neurobiology of pain: developmental aspects. Neuroscientist 2001; 7: 246-257
• 102 S3-Leitlinie. Behandlung acuter perioperativer und posttraumatischer Schmerzen. AWMF-Register Nr. 041/001
• 103 Hicks CL. The faces pain scale – revised toward a common metric in pediatric pain measurement. Pain 2001; 93: 173
• 104 Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain Intensity on the First Day after Surgery: A Prospective Cohort Study Comparing 179 Surgical Procedures. Anesthesiology 2013; 118: 934-944
• 105 Stewart DW, Ragg PG, Sheppard S, Chalkiadis GA. The severity and duration of postoperative pain and analgesia requirements in children after tonsillectomy, orchidopexy, or inguinal hernia repair. Paediatr Anaesth 2012; 22: 136-143
• 106 Stanko D, Bergesio R, Davies K, Hegarty M, von Ungern-Sternberg BS. Postoperative pain, nausea and vomiting following adeno-tonsillectomy – a long-term follow-up. Pediatr Anesth 2013; 23: 690-696
• 107 Messerer B, Gutmann A, Weinberg A, Sandner-Kiesling A. Implementation of a standardized pain management in a pediatric surgery unit. Pediatr Surg Int 2010; 26: 879-888
• 108 Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, Darrow DH, Giordano T, Litman RS, Li KK, Mannix ME, Schwartz RH, Setzen G, Wald ER, Wall E, Sandberg G, Patel MM. American Academy of Otolaryngology-Head and Neck Surgery Foundation . Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011; 144: S1-S30
• 109 Rakow H, Finke W, Mutze K, Reich A, Reinhold P, Strauß JM. Handlungsempfehlung zur perioperativen Schmerztherapie bei Kindern. Anästh Intensivmed 2007; 48: S99-S103
• 110 Kammerbauer N, Becke K. Acute pain therapy in children. Anasthesiol Intensivmed Notfallmed Schmerzther 2011; 46: 344-352
• 111 Rawlinson A, Kitchingham N, Hart C, McMahon G, Ong SL, Khanna A. Mechanisms of reducing postoperative pain, nausea and vomiting: a systematic review of current techniques. Evid Based Med 2012; 17: 75-80
• 112 Sun J, Wu X, Meng Y, Jin L. Bupivacaine versus normal saline for relief of post-adenotonsillectomy pain in children: a meta-analysis. Int J Pediatr Otorhinolaryngol 2010; 74: 369-373
• 113 Rawlinson A, Kitchingham N, Hart C, McMahon G, Ong SL, Khanna A. Mechanisms of reducing postoperative pain, nausea and vomiting: a systematic review of current techniques. Evid Based Med 2012; 17: 75-80
• 114 Murray KF, Hadzic N, Wirth S, Bassett M, Kelly D. Drug-related hepatotoxicity and acute liver failure. J Pediatr Gastroenterol Nutr 2008; 47: 395-405
• 115 Leroy S, Mosca A, Landre-Peigne C, Cosson MA, Pons G. Ibuprofen in childhood: evidence-based review of efficacy and safety. Arch Pediatr 2007; 14: 477-484