08 June 2009

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

0 comments:

All links posted here are collected from various websites. No video or powerpoint files are uploaded on this blog. If you are the original author and do not wish to display your content on this blog please Email me anandkumarreddy at gmail dot com I will remove it. The contents of this blog are meant for educational purpose and not for commercial use. If you use any content give due credit to the original author.

This site uses cookies from Google to deliver its services, to personalise ads and to analyse traffic. Information about your use of this site is shared with Google. By using this site, you agree to its use of cookies.

  © Blogger templates Newspaper III by Ourblogtemplates.com 2008

Back to TOP