Reversal, Extubation & Complications
🫁 Reversal & extubation
- ① Antiemetic — ondansetron 0.1 mg/kg + dexamethasone 0.1 mg/kg (dexamethasone also reduces oedema and pain).
- ② Throat pack removed (count checked) and the pharynx examined; ③ gentle suction under vision.
- ④ Extubate only once protective airway reflexes have returned — a smooth, awake extubation.
- ⑤ Position for extubation / recovery: lateral "tonsillar" (recovery) position, head slightly down — lets blood and secretions drain out of the mouth rather than pool.
Complications
Complications
Post-tonsillectomy bleedingSee next tab
Airway obstructionClot, oedema, laryngospasm
Laryngospasm
PONV & pain
Analgesia: multimodal & opioid-sparing — paracetamol + an NSAID (weighing the small bleeding risk), and dexamethasone. Opioids are titrated cautiously in the OSA child (heightened sensitivity to respiratory depression).