Adenotonsillectomy

Question 1

Indications for T&A

Answer 1

Nocturnal upper airway obstruction and sleep disordered breathing (most common)

Chronic/ recurrent infections

Question 2

Most common cause of OSA in children

Answer 2

Adenotonsillar hypertrophy

Question 3

Anesthetic considerations for children with OSA undergoing a T&A

Answer 3

Longer emergence from anesthesia
Lower dose of intraoperative opioid necessary
Higher incidence of postoperative airway obstruciton
Prolonged oxygen requirements
Greater need for airway instrumentation
Need hospital admission for 23 hours to monitor for airway obstruction

Question 4

What is the FDA warning concerning codeine for children undergoing a T&A?

Answer 4

Increased risk of death d/t respiratory depression in these pts

Question 5

Most common coagulation disorder in pts undergoing a T&A

Answer 5

Von Willebrand

Question 6

Consideration for pts who receive DDAVP

Answer 6

Risk of hyponatremia = use isotonic crystalloids at 1/2- 2/3 the calculated maintenance values

Question 7

Intraoperative considerations for T&A pts

Answer 7

Dexamethason 1mg/kg up to 25mg to reduce edema, pain, and PONV

Airway fire risk (FiO2 <40%)

NSAIDs are controversial

Ensure throat pack is removed

Suction airway carefully on emergence

Question 8

When does primary bleeding typically occur following a T&A?

Answer 8

Within 24 hours

Question 9

When does secondary bleeding typically occur following a T&A?

Answer 9

5-10 days post-op

Question 10

What blood loss percentage is associated with sx of dizziness and orthostatic hypotension?

Answer 10

> /= 20%

Question 11

Airway management for an active bleed following T&A

Answer 11

Preoxygenate in the left-lateral head down position
RSI w/ surgeon present prior to anesthetic induction
OGT after induction