This article reviews factors related to adverse events occurring during or after tonsillectomy with a focus on obstructive sleep apnea (OSA). Cases were submitted via a survey to members of the Society for Pediatric Anesthesia and review of the Anesthesia Closed Claims Program. Death or permanent neurological injury occurred in 77% of reported cases. Events occurred across the care spectrum from surgery to post-release at home. Fifty-seven percent of the children fulfilled the at risk criteria for OSA. At risk children were more likely to be obese and have co-morbidities. These are of particular concern in association with reported opioid sensitivity in children with OSA. Obesity, a history of OSA, and the use of postoperative opioids increase the risk of postoperative respiratory events. Better evaluation of these risk factors must occur, postoperative follow-up and monitoring with at risk children must be in place, and some children are not candidates for out-patient tonsillectomy.