Ultrasonic adenotonsillectomy for the treatment of obstructive sleep apnea in a child with hemophilia A

Abstract

Background: Adenotonsillectomy is now approved to be a primary treatment for obstructive sleep apnea syndrome (OSAS) in children. On the other hand, this surgery has historically been contraindicated in hemophilia. We show a case with OSAS and severe hemophilia A, in which adenotonsillectomy was successfully performed using an ultrasonic instrument. Case history: A 7-year-old boy with hemophilia A was diagnosed with OSAS by polysomnography (PSG). Since his adenoids and faucial tonsils remarkably hypertrophied, adenotonsillectomy was indicated. The preoperative screening tests exhibited that activated partial thromboplastin time was prolonged to 89.8 s and factor VIII was 1.1%. Fifty units per kilogram of the recombinant antihemophilic factor (Recombinate™, Baxter, USA) were administered preoperatively to obtain more than 100%, and 25 units/kg were given every 6 h for 12 days after surgery to maintain 50%. The ultrasonic scalpel (Harmonic Scalpel™, Ethicon Endosurgery, USA) was introduced into the operation for a complete hemostasis. As a result, intraoperative bleeding was successfully controlled to 8.5 g. He has been free from the disease after surgery. Conclusion: Adenotonsillectomy in a hemophilic child can be challenged using an ultrasonic instrument if the close collaboration of otolaryngologists and pediatricians is established.