Tonsillectomy/Adenoidectomy Flashcards
Why should nasal airways be avoided during the
induction of patients presenting for adenoidectomy if mask ventilation proves difficult?
Nasal airways can result in bleeding due to trauma caused to the hypertrophied adenoid tissue.
Name two patient populations in which
premedication should be avoided prior to a
tonsillectomy?
Patients with OSA, patients with symptoms of upper airway obstruction.
An adult patient arrives for a
tonsillectomy/adenoidectomy with fever, nasal
secretions, and purulent sputum. Should the patient continue with the planned procedure?
No. The patient is exhibiting signs of an acute URI. General guidelines advise for the postponement of any elective procedure until symptoms subside.
Once the mouth gag is applied, why is it imperative
to verify the position of the ETT?
The mouth gag can dislodge, kink, or obstruct the ETT, as evidenced by a change in chest movement, breath sounds, and PIP.
Following a tonsillectomy, what would alert you to
the possibility of an ongoing bleed?
Frequent swallowing
What type of extubation ensures the maximum
protection of an airway?
An awake extubation
Why should hypercapnia be avoided during
emergence in a patient who has undergone
tonsillectomy/adenoidectomy?
Hypercapnia casues vasodilation which can cause an increase in bleeding.
How is the patient positioned postoperatively
following a tonsillectomy?
The patient should be placed in the lateral position with the head facing downward. This is known as the “tonsillar position”.
Where is the ETT secured in a patient undergoing
tonsillectomy?
The ETT is placed midline and secured to the lower lip.
What are common preoperative diagnoses in
patients presenting for tonsillectomy and/or
adenoidectomy?
The most common diagnosis is chronic tonsillitis with or without adenoiditis. Other diagnoses include: OSA, snoring, peritonsillar abscess, nasal airway obstruction, and asymmetric enlargement of tonsils (this is done to rule out cancer).
How is a patient positioned for a tonsillectomy?
The patient is positioned supine with the shoulders elevated.
Should a pediatric patient presenting for
tonsillectomy with nasal congestion without fever
proceed with surgery or have the surgery postponed?
The surgery can proceed as scheduled. Patients that have fever with a productive cough and wheezing display symptoms involving the lower respiratory tract and should be rescheduled.
What impact can severe adenoidal hyperplasia have on the pediatric patient?
Sleep and speech disturbances, obligate mouth breathing, nasopharyngeal obstruction, and failure to thrive due to poor feeding can be seen in this patient population.
What are some possible postoperative complications following a tonsillectomy/adenoidectomy?
Laryngospasm, bleeding, retained throat pack (causing upper airway obstruction), postobstructive pulmonary edema
