Our Summary

This research paper discusses how the number of children getting their tonsils removed on an outpatient basis (meaning they go home the same day as the surgery) is increasing. The main reasons for this surgery are repeated throat infections and issues with breathing during sleep. The most common complications after the surgery are bleeding and problems with breathing.

In areas that don’t have a children’s hospital, these cases are often handled by doctors who are not specialized in pediatric care. In response to this, the Pediatric Committee of the Society for Ambulatory Anesthesia developed a set of recommendations for safely caring for children who undergo this surgery in standalone outpatient surgical facilities.

The recommendations aim to identify children who are more likely to experience complications and need additional care. The goal is to provide practical advice for health care professionals based on the best available evidence. When there’s no high-quality evidence available, the committee relied on the agreement of pediatric outpatient specialists. These recommendations were then presented to the Pediatric Committee of the Society for Ambulatory Anesthesia.

FAQs

  1. What are the main reasons for children to undergo tonsillectomy?
  2. What are the most common complications after tonsillectomy?
  3. What are the recommendations developed by the Pediatric Committee of the Society for Ambulatory Anesthesia for caring for children undergoing tonsillectomy in outpatient surgical facilities?

Doctor’s Tip

One helpful tip a doctor might tell a patient about tonsillectomy is to make sure to follow all post-operative instructions carefully, especially when it comes to managing pain and avoiding certain activities that could increase the risk of bleeding. It’s also important to stay hydrated and eat soft foods to help with healing. If you experience any concerning symptoms such as excessive bleeding, difficulty breathing, or signs of infection, be sure to contact your doctor immediately.

Suitable For

In general, patients who are recommended for a tonsillectomy are those who have:

  1. Recurrent throat infections: Children who have frequent episodes of tonsillitis or strep throat may be recommended for a tonsillectomy to prevent further infections.

  2. Sleep-disordered breathing: Patients who have obstructive sleep apnea, enlarged tonsils that are causing breathing problems during sleep, or other sleep-related breathing issues may be candidates for tonsillectomy.

  3. Enlarged tonsils: Tonsils that are significantly enlarged and causing issues such as difficulty swallowing, breathing, or speaking may also warrant a tonsillectomy.

  4. Chronic tonsillitis: Children who have chronic inflammation of the tonsils that does not respond to other treatments may be recommended for a tonsillectomy.

  5. Abscesses: Patients who develop peritonsillar abscesses, which are painful collections of pus near the tonsils, may require a tonsillectomy to prevent future abscesses.

It is important for healthcare professionals to carefully evaluate each patient’s individual case and consider the potential risks and benefits of a tonsillectomy before recommending the surgery. Additionally, following guidelines and recommendations for post-operative care can help reduce the risk of complications and ensure a successful recovery for patients undergoing tonsillectomy.

Timeline

Before the tonsillectomy:

  • The patient may have experienced repeated throat infections or issues with breathing during sleep, leading to the decision to have a tonsillectomy.
  • The patient and their family will meet with a doctor to discuss the surgery and its risks and benefits.
  • Preoperative testing may be done to ensure the patient is healthy enough for surgery.
  • The patient will be given instructions on fasting before the surgery and what medications to avoid.
  • The patient will be scheduled for the surgery and may have a preoperative appointment to go over any last-minute details.

After the tonsillectomy:

  • The patient will be monitored in the recovery room until they are awake and stable.
  • They may experience sore throat, pain, and difficulty swallowing in the days following the surgery.
  • The patient will be given instructions on how to care for their throat and manage pain at home.
  • Follow-up appointments may be scheduled to check on the healing process and address any concerns.
  • The patient will gradually return to their normal activities and diet as they recover.
  • Complications such as bleeding or breathing problems may occur, and the patient should seek medical attention if they experience these symptoms.

What to Ask Your Doctor

Some questions a patient should ask their doctor about tonsillectomy include:

  1. What are the potential risks and complications associated with a tonsillectomy?
  2. How long is the recovery period after the surgery?
  3. Will there be any dietary restrictions or special instructions to follow post-surgery?
  4. What pain management options will be available during the recovery period?
  5. How soon can the patient resume normal activities, such as school or work, after the surgery?
  6. Are there any specific signs or symptoms that indicate a need for immediate medical attention after the surgery?
  7. Will a follow-up appointment be scheduled after the surgery to monitor the patient’s recovery progress?
  8. What experience does the doctor have with performing tonsillectomies on children in an outpatient setting?
  9. Will there be a dedicated pediatric anesthesia provider present during the surgery?
  10. What measures will be taken to ensure the safety and comfort of the patient during and after the surgery?

Reference

Authors: Brennan MP, Webber AM, Patel CV, Chin WA, Butz SF, Rajan N. Journal: Anesth Analg. 2024 Sep 1;139(3):509-520. doi: 10.1213/ANE.0000000000006645. Epub 2024 Aug 16. PMID: 38517763