Tonsillectomy
Considerations
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Indication for surgery: obstructive sleep apnea (OSA), recurrent infections
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Potential OSA: difficult bag mask ventilation, pulmonary hypertension/RVF, respiratory depressant sensitivity, post-op monitoring
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Shared airway, oral rae ETT
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Need for smooth emergence (dexmedetomidine)
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Post-op complications: bleeding, negative pressure pulmonary edema, airway obstruction, apnea, PONV, pain
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Postoperative disposition (day surgery vs. admission vs. PICU)
Post-Tonsillectomy Bleed
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Considerations:
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Emergency with limited time to optimize
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Full stomach: RSI is essential, ensure gastric decompression at the end
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Potential for hypovolemia, ensure aggressive resuscitation
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Potentially difficult airway due to blood
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Call for help
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Have 2 suctions ready
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Styletted ETT
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Conflicts:
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Full stomach vs. hemodynamic instability
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Full stomach vs. difficult airway
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Volume resuscitate vs. emergency surgery for potential airway obstruction
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Criteria for Admission Post-op
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Age < 3 years
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Severe OSA
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Coagulation disorder
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Comorbid serious systemic disorders
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Child with craniofacial abnormality (e.g. Down Syndrome, Treacher Collins, Goldenhar, Crouzon, Pierre Robin, CHARGE)
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Situation not consistent with close observation (social issues, extended travel time)