World-first findings from the collaborative REACT study – a joint project between Telethon Kids, PCH, UWA and Curtin University – have led to the asthma medication Ventolin being routinely given to paediatric patients before tonsillectomy surgery to prevent respiratory complications.
REACT, a randomised clinical trial run from 2014 to 2017, demonstrated for the first time that simply giving a child two puffs of the over-the-counter medication Ventolin prior to anaesthesia significantly decreased respiratory complications – by 40 per cent – during and after tonsillectomy surgery, particularly in high risk children.
Since publication of the results in the international journal, JAMA Pediatrics, in April 2019, Ventolin has been implemented in multiple hospitals and institutions around the globe as the standard premedication prior to tonsillectomy, particularly across the US and Europe.
Lead researcher and PCH anaesthetist Professor Britta Regli-von Ungern-Sternberg said tonsillectomy was one of the most frequently performed surgical procedures in children, with around 40,000 carried out in Australia each year.
“Around 1,000 tonsillectomies were performed at PCH last year and up to half of those having this procedure will experience breathing problems at some stage during or after the procedure,” Professor Regli-von Ungern-Sternberg said.
“Although most of these complications are minor, such as easily managed airway obstructions and mild desaturations, others can be more serious and have long-term effects.”
Eight-year-old Lily Merema was one of almost 500 children who took part in the REACT study, undergoing a tonsillectomy at PCH.
“Every time Lily became sick with any little germ, she got tonsillitis and she would end up quite unwell,” Mum Michelle said. “She was also a really noisy sleeper, so we decided to get her tonsils out.
“Lily was the perfect candidate to help and we were just keen to contribute to the research. The surgery made a world of difference – her quality of sleep is better, and it seems to have improved the way her body responds generally when she is unwell.”
Left: Lily Merema ready to participate in the OSATS 2 Trial
Professor Graham Hall, Co-head of the Children’s Lung Health team at The Kids, worked closely with Professor Regli-von Ungern-Sternberg on the study and said the findings had changed the way children getting tonsillectomies are managed.
“We demonstrated a simple, inexpensive solution which is easy to implement, but has great benefit,” he said. “It is possible that Ventolin could also be beneficial for children, and adults for that matter, having other types of surgery.
“There is the potential for more research in this area.”
- REACT was a collaboration between The Kids Research Institute Australia, Perth Children’s Hospital (PCH), Perth Children’s Hospital Foundation, The University of Western Australia, and Curtin University.
- The trial was funded by the Perth Children’s Hospital Foundation and an Australia and New Zealand College of Anaesthetists (ANZCA) project grant.