Tonsillectomy & Adenoidectomy

Tonsillectomy & Adenoidectomy
Definition/Purpose of Procedure

* Removal of tonsils & adenoids by sharp or blunt dissection
* Adenoids are removed to facilitate breathing, prevent recurrent otitis media, and to restore hearing loss due to obstruction of the eustachian tube
Relevant A & P

Pathophysiology
* Upper aerodigestive tract
o Tonsillitis of the palatine tonsils
* Hypertrophy
Diagnostics
* Exams
o H & P
o Visual exam
o C & S
* Preop testing
o CBC: PTT-7 minutes

Special Considerations
* OR table position
* Order of extraction varies
* Best technique (not sterile)
* Surgeon may prefer to stand or sit
* Typical peds
* Adults: under local and sitting up

Surgical Intervention: Anesthesia
* General
o Peds mask induction
o Oral ET tube
o Lubricate and protect eyes

Surgical Intervention: Positioning
* Supine, neck hyperextended
* Supplies and equipment
o Neck roll
o Arm sleds or draw sheet
o Safety strap
o Foam headrest or donut
o Move patient to edge for ease of access
* Special considerations: high risk areas
Surgical Intervention: Skin Prep
Surgical Intervention: Draping/Incision
* Head wrap or cover sheet
* Peritonsillar incision
Surgical Intervention: Supplies
* General
small basin
* Specific
* Suture: 2-0 plain heavy, tapered 5/8 in needle
* Meds: local of choice (marcaine or lidocaine w/epinephrine)
Surgical Intervention: Instruments
* T & A set
* Sitting stool
* Headlamp
* ? Harmonic scalpel
* Suction apparatus
Procedure Steps
* See Exemplar and Procedure 17-6 STST
Counts

* Initial: sponges and sharps
* First closing
* Final closing
o Sponges
o Sharps
Specimen & Care
* Rt and left tonsils and adenoids
o Ask about separating—may “tag rt w/safety pin”
Postoperative Care
* Destination PACU—outpatient
* Position pt on side once extubated
* Elevate HOB
* Cold fluids
* Expected prognosis
o Return to normal activities within 2 wks
o Reduced incident of sore throat & ear infections
* Complications
* Hemorrhage up to 10 days post op
* Infection
* Wound Classification : II—increased for inflammation or infection
Resources
Tonsillectomy & Adenoidectomy