Tonsillectomy and Adenoidectomy (T & A)

Tonsillectomy and Adenoidectomy (T & A)

  • Children undergo T & A for obstructive sleep apnea, sleep disordered breathing, or recurrent tonsillitis. Especially with a history of obstructive sleep patterns, often the tonsils are very large and patients tend to severely obstruct on induction. These patients, especially those <3yo, are also at risk for airway obstruction in the PACU; many of these children are very sensitive to narcotics.
  • Premedication: versed 0.5-1 mg/kg in response to patient's need, clinical status, and parents' input.
  • Inhalational induction; airway obstruction is quite common but responsive to continuous positive airway pressure.
  • Peripheral IV
  • +/- muscle relaxant/propofol to facilitate intubation of the trachea with oral RAE tube; secure endotracheal tube to chin with tegaderm.
  • Bed turned 90
  • Ampicillin 25mg/kg plus decadron 0.5 mg/kg (max 10-12 mg, discuss with surgeon) pre-incision.
  • Generous IV fluids (oral intake is often poor postoperatively)
  • Trachea extubated either awake or under deep anesthesia, according to patient's status and preference of the anesthesiologist
Clinical Area: 
Type: 

 

This information is meant to serve as an educational resource. Clinicians should use their own professional judgment in the care of any individual patient as the guidance contained in this document may not be appropriate for all patients or all situations.