Tonsillectomy
Jun 16, 2024![](https://kajabi-storefronts-production.kajabi-cdn.com/kajabi-storefronts-production/file-uploads/blogs/2147545446/images/a52245a-edd6-173c-727-b0cc5f28c8b_Concept_Series_website_YouTube_Banner_-12.png)
🌟 What and why? 🌟
A tonsillectomy is a surgical procedure to remove the tonsils, which are two small glands located at the back of the throat. This procedure is commonly performed for recurrent tonsillitis, sleep-disordered breathing, infection, and in rare cases, for suspected malignancy.
🔍 Intraoperative considerations: 🔍
📍 Position: Supine with shoulder roll
⏱️ Duration: 20-30 mins
🌬️ Airway plan: Either south-facing RAE tube or reinforced LMA
💡 Expert tips:
The surgeon needs to place a retractor (Boyle-Davis gag) in the mouth, which can dislodge the LMA or kink the ETT. Be vigilant and communicate with the surgeon if you have ventilation issues.
🌟 Postoperative considerations: 🌟
💥 Pain: Moderate in children, moderate-severe in adults.
❗ Airway risks: Increased risk of laryngospasm, especially <12 years. Patients with severe sleep apnoea may need a high-acuity ward
🩸 Bleeding: Post-operative bleeding can occur early or late. Reintubation for bleeding tonsil requires an experienced team and usually a rapid sequence induction with suction ready!
🔄 Other:
Consider recovering in the left lateral “tonsil position” to avoid blood in the airway. Repeated swallowing of blood can result in underestimation of blood loss +/- vomiting. Paediatric patients have a high incidence of emergence delirium with tonsillectomy - protect the patient and protect the IV cannula!
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Ref: Turner, Grant, 'Ear, nose and throat surgery', in Rachel Freedman, and others (eds), Oxford Handbook of Anaesthesia, 5 edn, Oxford Medical Handbooks (Oxford, 2022; online edn, Oxford Academic, 1 Nov. 2021), accessed 13 June 2024.