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UM Guidelines
Pediatric Adenotonsillectomy for Obstructive Sleep Apnea Syndrome (OSAS): Observation Care

Inpatient and Surgical Care (ISC)

BCBST last reviewed December 21, 2016*

Exceptions may be required to comply with EPSDT & BlueCare® regulations.
Observation Care Admission Criteria
  • Observation may be appropriate for a patient 3 years of age or less with a diagnosis of OSAS who has risk factors for postoperative respiratory complications which include 1 or more of the following:
    • Severe OSAS on polysomnography
    • Cardiac complications of OSAS (e.g., right ventricular hypertrophy)
    • Failure to thrive
    • Obesity
    • Prematurity
    • Recent respiratory infection
    • Craniofacial anomalies
    • Neuromuscular disorders. See General Criteria: Observation Care guideline.
Observation Care Discharge Criteria
  • Discharge to nonacute care follow-up is appropriate for a patient with ALL of the following:
    • Procedure is completed
    • Physiologic recovery
    • Stable vital signs
    • Stable respiratory status
    • Patient alert
    • Temperature appropriate
    • Postoperative effects resolved or managed
    • Voiding status acceptable
    • Competent person available to accompany patient
    • No complicating features
  1. American Academy of Pediatrics. (2012, September). Clinical Practice Guideline: Diagnosis and management of childhood obstructive sleep apnea syndrome. Retrieved August 28, 2013 from http://pediatrics.aappublications.org/content/130/3/576.full.pdf.

  2. American Academy of Otolaryngology – Head and Neck Surgery. (2011, August). Clinical Practice Guideline: Tonsillectomy in children. Retrieved August 11, 2011 from http://oto.sagepub.com/content/144/1_suppl/S1.full.pdf+html.

  3. American Society of Anesthesiologist. (2014, February). Practice guidelines for the perioperative management of patients with obstructive sleep apnea. Retrieved September 7, 2016 from http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1917935.

  4. American Society of Anesthesiologist. (2011, October). Statement on practice recommendations for pediatric anesthesia. Retrieved September 17, 2012 from http://www.asahq.org/For‐Members/Standards‐Guidelines‐and‐Statements.aspx.

  5. BlueCross BlueShield of Tennessee network physicians. September – December 2016.

  6. Pediatrics. (2016, June). Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: Update 2016. Retrieved September 7, 2016 from http://pediatrics.aappublications.org/content/early/2016/06/24/peds.2016‐1212.



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