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Questions and Answers
What is the purpose of a mouth gag in tonsillectomy?
To prevent the mouth from closing during operative procedures of the mouth or throat.
What is a common problem in patients undergoing tonsillectomy due to chronic infection?
Obstructive sleep apnea.
What is the significance of a history of snoring in patients undergoing tonsillectomy?
It may indicate airway problems.
What is the purpose of EMLA cream in premedication for tonsillectomy?
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Why should sedation be avoided in some patients undergoing tonsillectomy?
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What is the importance of warming the anesthetic room and theatre in tonsillectomy?
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What is the typical length of surgery for tonsillectomy?
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What is a common postoperative complication of tonsillectomy?
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What is essential to perform before inducing anesthesia in a patient who has not fully recovered from recent anesthesia?
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Why is the head-down position recommended during induction of anesthesia in a patient with recent anesthesia?
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What is the purpose of cricoid pressure during inhalational induction of anesthesia?
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Why is it essential to wash out the stomach with a nasogastric tube before extubation?
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What is a potential complication of heavy sedation in the postoperative period?
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What is the importance of checking hemoglobin levels postoperatively?
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What are the two options for inducing anesthesia in a patient?
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What is the purpose of using Suxamethonium or a non-depolarizing muscle relaxant during endotracheal intubation?
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Why is it important to protect the patient's eyes during anesthesia?
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What is the purpose of giving analgesia intra-operatively?
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What is the advantage of using an oral RAE tube during anesthesia?
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What is the usual method of providing analgesia post-operatively?
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Why is it rare to require intravenous fluids post-operatively?
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What is a potential complication of post-tonsillectomy bleeding?
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Study Notes
Anesthesia for Tonsillectomy
- Tonsillectomy is a surgical procedure where the tonsils are removed through the mouth using a mouth gag, which is a surgical device placed between the upper and lower jaws to prevent the mouth from closing during the operation.
Specific Problems
- Shared airway with the surgeon
- Difficult intubation due to marked lymphoid hypertrophy or infection
- The mouth gag may obstruct the tracheal tube
- Postoperative bleeding leading to airway disruption and/or hypotension
Patient Characteristics
- Typically ASA 1 or 2
- Children or young adults
- May have chronic infection (tonsillitis) and/or obstructive sleep apnea
- Many centers treat patients as day cases
Preoperative Assessment and Investigations
- History: particularly of snoring and airway problems
- Investigations: complete blood count (CBC) and relevant tests according to need
Premedication
- In younger children: Diazepam syrup may be given 2 hours preoperatively
- EMLA cream may be applied to the venipuncture site at least 1 hour preoperatively
- For older children and adults: Midazolam may be given
- No sedation if there is airway obstruction or difficulty
Perioperative Management
- The anesthetic room and theatre should be warm to minimize heat loss
- Surgery typically takes 20-45 minutes
- Monitoring: noninvasive blood pressure, pulse oximetry, and body temperature
Anesthetic Technique
- Induction: either inhalational or intravenous drugs
- Endotracheal intubation facilitated by Suxamethonium or a non-depolarizing muscle relaxant
- A smaller tube than expected may be necessary
- Maintenance: oxygen and a volatile agent, with the patient breathing spontaneously or having ventilation assisted
- Analgesia: may be given intra-operatively to ensure pain-free emergence
- Extubation: performed with the patient head down and in the lateral position, using an oral RAE tube
Postoperative Management
- Analgesia: intramuscular or intravenous opioids, NSAID, Diclofenac suppositories, and Paracetamol
- Intravenous fluids are rarely required routinely
- Discharge: careful evaluation and assessment of the patient reduces the re-admission rate for complications
- Most bleeding occurs prior to discharge or later than 24 hours after operation
Management of Post-Tonsillectomy Bleeding
- Problems: stomach full of blood, risk of vomiting and aspiration, hypovolemia, hypotension, difficult airway, and recent anesthesia
- Anesthetic management: experienced anesthetist present, resuscitation prior to induction, IV fluid and blood, monitoring, and effective suction
- Rapid sequence induction with Thiopentone and Suxamethonium, and maintenance anesthesia as before
- Prior to extubation, wash out the stomach by a nasogastric tube and extubate with head down and on the side
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Description
Learn about the anesthesia considerations for tonsillectomy, including managing the shared airway, difficult intubation, and postoperative bleeding.
