Anesthesia for Tonsillectomy
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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?

<p>To reduce pain at the venipuncture site.</p> Signup and view all the answers

Why should sedation be avoided in some patients undergoing tonsillectomy?

<p>If there is airway obstruction or difficulty.</p> Signup and view all the answers

What is the importance of warming the anesthetic room and theatre in tonsillectomy?

<p>To minimize heat loss and prevent hypothermia.</p> Signup and view all the answers

What is the typical length of surgery for tonsillectomy?

<p>Between 20 and 45 minutes.</p> Signup and view all the answers

What is a common postoperative complication of tonsillectomy?

<p>Postoperative bleeding leading to airway disruption and/or hypotension.</p> Signup and view all the answers

What is essential to perform before inducing anesthesia in a patient who has not fully recovered from recent anesthesia?

<p>Resuscitation, intravenous fluid and blood administration, and monitoring</p> Signup and view all the answers

Why is the head-down position recommended during induction of anesthesia in a patient with recent anesthesia?

<p>To prevent aspiration</p> Signup and view all the answers

What is the purpose of cricoid pressure during inhalational induction of anesthesia?

<p>To prevent passive regurgitation</p> Signup and view all the answers

Why is it essential to wash out the stomach with a nasogastric tube before extubation?

<p>To prevent aspiration</p> Signup and view all the answers

What is a potential complication of heavy sedation in the postoperative period?

<p>Airway obstruction</p> Signup and view all the answers

What is the importance of checking hemoglobin levels postoperatively?

<p>To detect any bleeding or anemia</p> Signup and view all the answers

What are the two options for inducing anesthesia in a patient?

<p>Inhalational or intravenous drugs</p> Signup and view all the answers

What is the purpose of using Suxamethonium or a non-depolarizing muscle relaxant during endotracheal intubation?

<p>To facilitate the procedure</p> Signup and view all the answers

Why is it important to protect the patient's eyes during anesthesia?

<p>To prevent dryness of the eye cornea</p> Signup and view all the answers

What is the purpose of giving analgesia intra-operatively?

<p>To ensure the patient is pain-free on emergence</p> Signup and view all the answers

What is the advantage of using an oral RAE tube during anesthesia?

<p>It is easily positioned centrally in the mouth</p> Signup and view all the answers

What is the usual method of providing analgesia post-operatively?

<p>Intramuscular or intravenous opioids, NSAID, Diclofenac suppositories, or Paracetamol</p> Signup and view all the answers

Why is it rare to require intravenous fluids post-operatively?

<p>Oral intake usually begins when the patient returns to the ward and has recovered adequately</p> Signup and view all the answers

What is a potential complication of post-tonsillectomy bleeding?

<p>Vomiting and aspiration of stomach contents</p> Signup and view all the answers

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.

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