Anaesthesia for the bleeding tonsil

Abstract

Tonsillectomy is a common procedure, with over 50 000 operations performed annually in the UK (Royal College of Surgeons of England, 2005). Just over half of these patients are under 15 years of age. Postoperative complications of a tonsillectomy include dysphagia, nausea and vomiting, pain, infection and bleeding.

Classical versus controlled rapid sequence induction and intubation in children with bleeding tonsils (a retrospective audit)

“…This, however, occurred without scientific, clinical evidence concerning adverse events, complications and outcomes of one or the other technique used in young patients with post‐tonsillectomy haemorrhage. Notwithstanding the technique chosen, it is recommended that a highly experienced anaesthetist should deal with this challenging and complex situation …”

Pediatric Anesthesia Management for Post-Tonsillectomy Bleed: Current Status and Future Directions

“…The literature on anesthesia management of posttonsillectomy hemorrhage is relatively sparse. Aside from short papers or sections in manuscripts on otolaryngologic emergencies [10][11][12][13]18 and a single center study from 1973, 14 only three recent papers have examined PTH and anesthesia. In particular, an anesthesiology education article on simulation training 15 and two single center retrospective studies have focused on the anesthetic management of PTH patients.…”

“…Endotracheal tubes of varying sizes to accommodate airway edema and two suction systems should be available in cases of heavy bleeding in case one suction catheter becomes obstructed with blood clot. 10 While inhalation induction in the lateral decubitus position has been described, 13,14,18 contemporary practice of pediatric anesthesia usually endorses intravenous induction. We will first explore the choice of classical (apneic) rapid sequence induction and intubation (RSII) versus controlled RSII with gentle bag-mask ventilation.…”

“…While inhalation induction in the lateral decubitus position has been described, 13 , 14 , 18 contemporary practice of pediatric anesthesia usually endorses intravenous induction. We will first explore the choice of classical (apneic) rapid sequence induction and intubation (RSII) versus controlled RSII with gentle bag-mask ventilation.…”