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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 209.
Name two patient populations in which
premedication should be avoided prior to a
tonsillectomy?
Patients with OSA, patients with symptoms of upper airway
obstruction.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 209
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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 209.
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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 210.
Following a tonsillectomy, what would alert you to
the possibility of an ongoing bleed?
Frequent swallowing
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 211.
What type of extubation ensures the maximum
protection of an airway?
An awake extubation
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 208.
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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 208.
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”.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 210.
Where is the ETT secured in a patient undergoing
tonsillectomy?
The ETT is placed midline and secured to the lower lip.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 208.
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).
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 207.
How is a patient positioned for a tonsillectomy?
The patient is positioned supine with the shoulders elevated.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 208.
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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 1211.
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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 1213.
What are some possible postoperative complications
following a tonsillectomy/adenoidectomy?
Laryngospasm, bleeding, retained throat pack (causing upper
airway obstruction), postobstructive pulmonary edema
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 211.
