Tonsillectomy & Tonsillectomy & AdenoidectomyAdenoidectomy

See Exemplar ProvidedSee Exemplar Provided

ObjectivesObjectives

Assess the anatomy, physiology, and Assess the anatomy, physiology, and pathophysiology of the tonsillectomy & pathophysiology of the tonsillectomy & adenoidectomyadenoidectomy

Analyze the diagnostic and surgical Analyze the diagnostic and surgical interventions for a patient undergoing interventions for a patient undergoing a _______________.a _______________.

Plan the intraoperative course for a Plan the intraoperative course for a patient undergoing_____________.patient undergoing_____________.

Assemble supplies, equipment, and Assemble supplies, equipment, and instrumentation needed for the instrumentation needed for the procedure.procedure.

ObjectivesObjectives

Choose the appropriate patient Choose the appropriate patient positionposition

Identify the incision used for the Identify the incision used for the procedureprocedure

Analyze the procedural steps Analyze the procedural steps for_____________.for_____________.

Describe the care of the specimenDescribe the care of the specimen Discuss the postoperative Discuss the postoperative

considerations for a patient considerations for a patient undergoing _______________undergoing _______________

Terms & DefinitionsTerms & Definitions

AAAdenoidsAdenoids EpiglottisEpiglottis FaucesFauces GlottisGlottis

LarynxLarynx Palatine Palatine

TonsilsTonsilsPapillomPapillomaa

PharynxPharynx

StomatitiStomatitiss

ThyroidThyroid

CartilageCartilageTracheaTrachea Vocal Vocal

CordsCords

Definition/Purpose of Definition/Purpose of ProcedureProcedure

Removal of tonsils & adenoids by Removal of tonsils & adenoids by sharp or blunt dissectionsharp or blunt dissection

Adenoids are removed to Adenoids are removed to facilitate breathing, prevent facilitate breathing, prevent recurrent otitis media, and to recurrent otitis media, and to restore hearing loss due to restore hearing loss due to obstruction of the eustachian obstruction of the eustachian tubetube

Relevant A & PRelevant A & P

Relevant A & PRelevant A & P

See Video clip See Video clip www.nucleusinc.comwww.nucleusinc.com

PathophysiologyPathophysiology

Upper aerodigestive tractUpper aerodigestive tract Tonsillitis of the palatine tonsilsTonsillitis of the palatine tonsils

Terms & DefinitionsTerms & Definitions

HypertrophyHypertrophy

DiagnosticsDiagnostics

ExamsExams H & PH & P Visual examVisual exam C & SC & S

Preop testingPreop testing CBC: PTT-7 minutesCBC: PTT-7 minutes

Surgical Intervention:Surgical Intervention:Special ConsiderationsSpecial Considerations

OR table positionOR table position Order of extraction variesOrder of extraction varies Best technique (not sterile)Best technique (not sterile) Surgeon may prefer to stand or Surgeon may prefer to stand or

sitsit Typical pedsTypical peds Adults: under local and sitting upAdults: under local and sitting up

Surgical Intervention: Surgical Intervention: AnesthesiaAnesthesia

GeneralGeneral Peds mask inductionPeds mask induction Oral ET tubeOral ET tube Lubricate and protect eyesLubricate and protect eyes

Surgical Intervention: Surgical Intervention: PositioningPositioning

Supine, neck hyperextendedSupine, neck hyperextended Supplies and equipmentSupplies and equipment

Neck rollNeck roll Arm sleds or draw sheetArm sleds or draw sheet Safety strapSafety strap Foam headrest or donutFoam headrest or donut Move patient to edge for ease of Move patient to edge for ease of

accessaccess Special considerations: high risk Special considerations: high risk

areasareas

Surgical Intervention: Skin Surgical Intervention: Skin PrepPrep

N/AN/A

Surgical Intervention: Surgical Intervention: Draping/IncisionDraping/Incision

Head wrap or cover sheetHead wrap or cover sheet Peritonsillar incisionPeritonsillar incision

Surgical Intervention: SuppliesSurgical Intervention: Supplies

GeneralGeneral ½ sheet x 2; raytex; towels; gowns & gloves, ½ sheet x 2; raytex; towels; gowns & gloves,

suction tubing, ESU w/extension; small basinsuction tubing, ESU w/extension; small basin

SpecificSpecific Suture: Suture: 2-0 plain heavy, tapered 5/8 in 2-0 plain heavy, tapered 5/8 in

needleneedle Meds: local of choice (marcaine or Meds: local of choice (marcaine or

lidocaine w/epinephrine)lidocaine w/epinephrine) Tonsil spongesTonsil sponges # 12 knife blade# 12 knife blade Insulated suction cauteryInsulated suction cautery Syringe for irrigationSyringe for irrigation Supplies for local (needle, syringe)Supplies for local (needle, syringe)

Surgical Intervention: Surgical Intervention: InstrumentsInstruments

T & A setT & A set

Surgical Intervention: Surgical Intervention: EquipmentEquipment

Sitting stool Sitting stool HeadlampHeadlamp ? Harmonic scalpel? Harmonic scalpel Suction apparatusSuction apparatus

Surgical Intervention: Surgical Intervention: Procedure StepsProcedure Steps

See Exemplar and Procedure 17-See Exemplar and Procedure 17-6 STST6 STST

CountsCounts

Initial: sponges and sharpsInitial: sponges and sharps First closingFirst closing Final closingFinal closing

SpongesSponges SharpsSharps

Specimen & CareSpecimen & Care

Rt and left tonsils and adenoidsRt and left tonsils and adenoids Ask about separating—may “tag rt Ask about separating—may “tag rt

w/safety pin”w/safety pin”

Postoperative CarePostoperative Care

Destination PACU—outpatient Destination PACU—outpatient Position pt on side once extubatedPosition pt on side once extubated Elevate HOBElevate HOB Cold fluidsCold fluids Expected prognosisExpected prognosis

Return to normal activities within 2 Return to normal activities within 2 wkswks

Reduced incident of sore throat & Reduced incident of sore throat & ear infectionsear infections

Postop CarePostop Care

ComplicationsComplications Hemorrhage up to 10 days post Hemorrhage up to 10 days post

opop InfectionInfection Wound Classification : II—Wound Classification : II—

increased for inflammation or increased for inflammation or infection infection

ResourcesResources

STST Procedure 17-6STST Procedure 17-6 STST pp. 618STST pp. 618