Tonsillectomy and Adenoidectomy (TA)
Anesthesia Implications
Position: Supine, arms tucked, head slightly extended, Bed turned 90 degrees
Time: 30-60 min (short)
Blood Loss: Low (10-50 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: No
- GETT
ETT – It is very common in this procedure to use the oral RAE. The ETT is typically secured to the middle of the chin and an extender is used to get the tubing further from the surgical field. Whether you use an oral RAE or a regular ETT, be aware that the ETT can kink on the lower lip/teeth and occlude the tube.
Reduce FiO2 – After the ETT is secure, decrease the FiO2 to less than 30.
From the Pros – LTA with lidocaine can be used to spray the vocal cords and reduce occurrence of bucking/ETT stimulation. If LTA is unavailable, may consider using lidocaine jelly on the cuff of the ETT prior to intubation. IV Precedex may also be used to reduce bucking, and promote a smooth extubation.
Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms
