Tonsillar Retractor Use Raises ICP and IOP During Adenotonsillectomy: Study
Researchers have found in a new study that use of a tonsillar retractor during adenotonsillectomy causes a rapid and significant increase in intracranial and intraocular pressure, warranting caution in pediatric patients at risk of sympathetic surges.
The tonsillar retractor used during adenotonsillectomy, one of the most common pediatric surgeries, may increase sympathetic activity. This study aimed to evaluate the effect of tonsillar retractor insertion on intracranial pressure (ICP) and intraocular pressure (IOP) in children undergoing adenotonsillectomy. This prospective observational study included 24 pediatric patients undergoing adenotonsillectomy and 20 age-matched controls undergoing other surgeries. Bilateral optic nerve sheath diameters (ONSD) were measured by ultrasonography, and intraocular pressure was assessed by tonometry before and immediately after tonsillar retractor insertion. Hemodynamic parameters were also recorded at the same time points and compared between groups. Pressure changes were analysed using the Generalised Estimating Equation method, and effect sizes were calculated with Cohen's d.
Insertion of the tonsillar retractor caused a significant increase in mean optic nerve sheath diameters from 4.66 ± 0.58 mm to 5.61 ± 0.52 mm (p < 0.001, d = 2.36). Mean intraocular pressure rose significantly from 13.7 ± 2.8 mmHg to 18.2 ± 5.3 mmHg (p < 0.001, d = 0.97). Systolic blood pressure increased from 100.4 ± 10.1 mmHg to 108.5 ± 10.8 mmHg (p = 0.0008), whereas diastolic pressure changes were not significant (p = 0.097). No significant correlation was found between changes in optic nerve sheath diameters and intraocular pressure (r = −0.22, p = 0.30). Tonsillar retractor use during adenotonsillectomy results in a rapid, marked rise in intracranial pressure and intraocular pressure. These findings should be considered by otolaryngologists and anesthesiologists managing pediatric patients at risk of sympathetic surges.
Reference:
A.Bozkurt Oflaz, M.Isık, M.Onal, M. K.Bozkurt, O.Onal, and B.Bozkurt, “Effect of Tonsillar Retractor on Intracranial and Intraocular Pressure in Children Undergoing Adenotonsillectomy Surgeries,” Laryngoscope Investigative Otolaryngology11, no. 2 (2026): e70357, https://doi.org/10.1002/lio2.70357.
Keywords:
Tonsillar, Retractor , Use, Raises , ICP, IOP, During, Adenotonsillectomy, Study, A.Bozkurt Oflaz, M.Isık, M.Onal, M. K.Bozkurt, O.Onal, and B.Bozkurt,
