International Journal of General Medicine (Jan 2022)
Pediatric Anesthesia Management for Post-Tonsillectomy Bleed: Current Status and Future Directions
Abstract
Angela C Lee,1 Manon Haché2 1Division of Anesthesiology, Pain and Perioperative Medicine, Children’s National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA; 2Division of Pediatric Anesthesia, Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USACorrespondence: Angela C LeeDivision of Anesthesiology, Pain and Perioperative Medicine, Children’s National Hospital, George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue NW, Suite M2601, Washington, DC, 20010, USATel +1 202 476 2025Fax +1 202 476 5999Email [email protected]: After medical stabilization, several techniques are considered for anesthesia in the surgical intervention of post-tonsillectomy bleeding in children. Hypoxia during induction of general anesthesia occurs more frequently than aspiration for this population. While classical (apneic) rapid sequence induction and intubation with cricoid pressure still has a role, controlled rapid sequence induction and intubation that incorporates mask ventilation at low pressure (< 12 cm H2O) before direct laryngoscopy under a deep plane of anesthesia is a viable alternative for cases of slow venous bleeding. Supplemental oxygen delivery during laryngoscopy to permit apneic oxygenation is a future trend in management. While the routine administration of tranexamic acid during tonsillectomy has not been shown to be of benefit, it may have a role in post-tonsillectomy hemorrhage with further study.Keywords: post-tonsillectomy hemorrhage, pediatric, postoperative emergencies, anesthetic management
