I have a 4.5yo son who we were recently told has severe obstructive sleep apnea.  He had a sleep study done in July and though I don't have the results in hand yet, the doctor told us that he his O2 sats were never very low, but that he had an average of 23 "episodes" an hour.  It wasn't specified what type of episodes they were.  So we have an appt. with an ENT on tuesday to discuss having a T&A.  I'm not sure what questions I need to ask at the appt.  I should have the study results in hand by that time so I know a little bit more about what it said exactly.  I don't know what method is best for the surgery.  The doctor who told us the results said that he will probably be in a PICU following the surgery but our local hospital doesn't have one.  We are within 30mins of several hospitals that do have PICUs however.  How important is it that he be in a PICU.  Is it something I should fight for if the ENT says it isn't necessary?  Any questions that are important for me to ask?  I would appreciate any info, suggestions, or help.  Thanks!

Why will he be in the PICU?  Does he have other health problems?  Was this a pediatrician who told you this?
Are you seeing a pediatric ENT?

I don't believe that the ENT is a peds ENT.  The sleep doc (who is also our ped) told us he would probably be in a PICU.  My husband and I have discussed that issue and we both think we would be more comfortable with a PICU rather than a regular ward.  Mainly because he has a history of asthma and other respiratory issues along with the OSA.  He has been hospitalized numerous times for pneumonias and asthma.  Considering the possible complications with his airway and the issues he already has, we both would rather him be in a PICU where any complications could be dealt faster and easier.  But of course we haven't seen the ENT yet, so we will wait and see what he has to say on the subject.

I guess I am having trouble understanding whether or not the sleep doctor is a pediatrician.  I'm impressed there is a pediatrician who practices general peds who is also board certified in sleep medicine.

Plenty of kids with asthma, pneumonias, and OSA get their tonsils out, but they are not put in a PICU afterwards.  That's why I'm confused.

My youngest son has had a handful of surgeries, and there are always kids who have been on-and-off ill and have the same issues getting their tonsils out for OSA who go home the same day...

Docs around here tend to be conservative....

Yes the sleep doc is also our pediatrician.  She has (I don't know how long), been seeing patients at a sleep center also.  I truly don't know if she is board certified currently or not, but I do know that she practices under one who is and that doc reviews all of her cases.  As far as the PICU, I'm just saying what we have been told, that there is a possibility of the PICU.  As far as staying overnight, all the things I have read about OSA and T&A have said that staying overnight is a good idea.  To me conservative means erring on the side of caution, I would rather the doctors be conservative...

Well, I didn't mean conservative like who they voted for.  

Still, the children here do not stay in the PICU.  Some of them go home, some of them stay overnight.  It really depends on the child and the doc.  Granted there are several PICUs here though...so transfer would not be 30 minutes away.  And if they stayed overnight, there is a PICU in the children's hospital, so they could easily and rapidly be transfered to that floor.

I think erring on the side of caution would be staying overnight in a hospital with a PICU...and being xfered to the PICU if necessary.

Just my opinion...having been to the PICU, I wouldn't want my child in there unless they HAD TO BE.

I would also work only with a ped ENT in cases of OSA and T&A because I think they will be more cautious about their approach with this situation.

This is just my opinion.  And I'm not at all meaning to sound rude. I apologize if it came across that way.  I'm rushing around getting ready to go to the hospital for my sons early tomorrow morning.