Tonsillectomy 

 

 

Considerations 

 

  • Indication for surgery: obstructive sleep apnea (OSA), recurrent infections 

  • Potential OSA: difficult bag mask ventilation, pulmonary hypertension/RVF, respiratory depressant sensitivity, post-op monitoring

  • Shared airway, oral rae ETT

  • Need for smooth emergence (dexmedetomidine)

  • Post-op complications: bleeding, negative pressure pulmonary edema, airway obstruction, apnea, PONV, pain

  • Postoperative disposition (day surgery vs. admission vs. PICU)

 

 

Post-Tonsillectomy Bleed 

 

  • Considerations: 

    • Emergency with limited time to optimize

    • Full stomach: RSI is essential, ensure gastric decompression at the end

    • Potential for hypovolemia, ensure aggressive resuscitation  

    • Potentially difficult airway due to blood

      • Call for help 

      • Have 2 suctions ready

      • Styletted ETT  

  • Conflicts:

    • Full stomach vs. hemodynamic instability

    • Full stomach vs. difficult airway

    • Volume resuscitate vs. emergency surgery for potential airway obstruction

 

 

Criteria for Admission Post-op 

 

  • Age < 3 years 

  • Severe OSA 

  • Coagulation disorder 

  • Comorbid serious systemic disorders 

  • Child with craniofacial abnormality (e.g. Down Syndrome, Treacher Collins, Goldenhar, Crouzon, Pierre Robin, CHARGE) 

  • Situation not consistent with close observation (social issues, extended travel time)  

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