"Adenotonsillectomy concentrates several hazards into one small patient — a shared airway, obstructive sleep apnoea, a vascular field, and the feared post-tonsillectomy bleed. This topic is split into short, focused tabs; read them in order or jump to what you need."
How to use this topic — CritCare.in.Why Tonsillectomy Is a Classic Paediatric Case
"Adenotonsillectomy is one of the commonest paediatric operations, yet it concentrates several hazards into one small patient: a shared airway worked by the surgeon, a child often operated on for obstructive sleep apnoea, a highly vascular field, and the ever-present risk of post-tonsillectomy bleeding returning as a hypovolaemic child with a stomach full of blood."
Synthesised from Miller's Anesthesia & Morgan & Mikhail's Clinical Anesthesiology.- Paediatric patient — infant/child physiology, ↓ FRC, high O₂ consumption, temperature and blood-volume sensitivity.
- Shared airway — the surgeon and anaesthetist work in the same field; the mouth gag can kink, compress or dislodge the tube.
- Obstructive sleep apnoea (OSA) — sensitised to opioids, prone to obstruction and post-op respiratory events; may have pulmonary hypertension.
- Bleeding — a vascular field, blood loss hard to estimate, and the feared post-tonsillectomy haemorrhage.
- PONV — one of the most emetogenic paediatric operations.
Indications
| Indication | Detail |
|---|---|
| Obstruction / OSA | The commonest modern indication — adenotonsillar hypertrophy causing obstructive sleep-disordered breathing |
| Recurrent infection (Paradise criteria) | ≥7 episodes in 1 year · ≥5/year for 2 years · ≥3/year for 3 years; or >2 weeks of missed school |
| Peritonsillar abscess (quinsy) | Not responding to medical management / recurrent |
| Chronic tonsillitis · Strep carrier · Suspected neoplasm | Chronic disease, streptococcal carriage, or unilateral enlargement raising malignancy concern |
Contraindications
① Deranged coagulation profile · ② Active infection (defer) · ③ Partial/complete cleft lip or palate — risk of velopharyngeal insufficiency after removing the adenoids/tonsils · ④ Hb < 10 g/dL (optimise first).
Pre-operative Assessment
History (adenotonsillitis & OSA), the adenoid facies, Brodsky grading, investigations and preparation.
🎯02 · INTRA-OPIntra-operative Management
Goals, OT prep, induction & intubation, the shared airway & Rose position, maintenance and LA infiltration.
🛏️03 · EXTUBATIONExtubation & Complications
Antiemetics, throat-pack removal, awake lateral extubation, and the complications.
🩸04 · POST-TONSILLECTOMY BLEEDThe Bleeding Child
Haemorrhage types, the five problems, resuscitation and the definitive RSI anaesthetic; the coroner's clot.
🎓05 · PEARLSMistakes, Pearls & References
Common mistakes, viva-ready exam pearls and references.