- Paediatric ENT
- Rebleed
- Primary within 24 hrs
- Secondary up to 28 days
- Risk factors
- Children
- Quincy/recurrent tonsillitis
- Diathermy surgical technique
- Assessment
- HR, RR, CRT, u.o.
- IV access, FBC, U&E, CS, G&S
- Pre-op resuscitation is mandatory
- Consider induction in L lateral position
- RSI versus gas induction
- 2x suction
- Empty stomach at end of procedure with ngt
- Ear surgery
- Myringotomy
- Small subset may have OSAS
- Mild pain post-op
- Usually combined with grommet insertion
- Myringoplasty, tympanoplasty and mastoidectomy
- Typically older children
- Longer procedure
- Avoid N₂O in middle ear
- Facial nerve monitoring may be used
- Head up to avoid venous ooze
- Deep anaesthesia to avoid movement or hypertension
- Consider ventilation to control CO₂ to help with bleeding
- Consider remifentanil
- Analgesia is multimodal with morphine used at the end
- BAHA
- Often have associated congenital abnormalities
- Congenital heart disease
- Anaesthesia for tonsillectomy
- Airway management
- Shared airway
- Reinforced LMA vs ETT
- LMA
- Easy
- No soiling of airway with blood
- Smooth emergence
- Minimal trauma
- Less secure
- May impair surgical access
- ETT
- More secure
- Good surgical access
- Risk of trauma
- Requires paralysis
- Problems with extubation & reversal
- Analgesia
- NSAID & paracetamol
- Dexamethasone reduces analgesia requirement
- LA around tonsillar beds does not help
- PONV
- Avoid nitrous
- Dexamethasone
- Ondansetron
- Cyclizine 1mg/kg
- Fluids
- Extended observation for 4-6 hrs
- Tonsillectomy
- Present with nasal obstruction, recurrent URTI, secretory otitis media, deafness and OSAS
- Indicated if >5 episodes of tonsillitis per yr or persisted for >1 yr and are disabling, OSAS, peri tonsillar abscess, chronic tonsillitis
- OSAS patients are not suitable for daycase
- Also must be > 3yrs old
- Live within 1 hr
- CEACCP
Link:ceaccp.oxfordjournals.org/content/7/2/33.full.pdf