Parents were allowed to be present during induction of anesthesia. All children had routine monitors that consisted of electrocardiogram, automatic blood pressure cuff, finger pulse oximeter probe, peripheral nerve stimulator, and a precordial stethoscope placed before or soon after induction of anesthesia.
All children received 0. At the end of surgery, halothane was adjusted to 0. Atropine 0. At the surgeon's request, 0. Intravenous fluids were administered in a volume sufficient to restore calculated fluid deficits, fulfill maintenance requirements, and compensate for measured blood loss. Gastric contents were aspirated before extubation in all children. At the end of surgery defined as removal of the mouth gag by the surgeon , the anesthetics were turned off, and neuromuscular blockade was antagonized with 0.
The trachea was extubated in the operating room when criteria for extubation were met. Complications, such as airway obstruction, laryngospasm, or desaturation not responding to airway interventions, such as jaw thrust, continuous positive airway pressure, or insertion of an oral airway, and requirement of emergent endotracheal intubation during anesthetic induction or after emergence of anesthesia were noted.
Postoperatively, an experienced nurse observer blinded to the anesthetic technique documented recovery events at specified intervals, including the modified Aldrete score in the postanesthesia care unit PACU , the length of the stay in the PACU, the number and frequency of emetic episodes, analgesic requirements, oral intakes, discharge-to-home times, and complications, such as airway obstruction and primary hemorrhage.
After discharge to home, the same nurse, after a follow-up phone call to the parents 24 h postoperatively, noted analgesic requirements, the number and frequency of emetic episodes, and side effects.
Vomiting in the hospital was treated after two episodes with 0. Subsequent recurrent vomiting was treated at the physician's discretion. Anesthesia time was defined as the time from anesthetic induction until arrival in the PACU. The surgical time was measured from surgical incision to removal of the mouth gag by the surgeon.
The times to extubation and eye opening were measured from the end of anesthesia to the time of tracheal extubation and spontaneous eye opening, respectively. Tracheal extubation occurred in the operating room when criteria for extubation were met.
Extubation criteria were based on the return of protective airway reflexes, spontaneous regular breathing and purposeful movements by the patient, and a 5-s sustained response to a Hz tetanic stimulation. The PACU time was recorded from the time of extubation until a modified Aldrete score of 10 was reached. The discharge time was defined as the time from reaching a modified Aldrete score of 10 until the discharge to home criteria were met.
Discharge to home criteria included having a minimum stay of 2 h postextubation and having drank ml of clear liquid without vomiting. Because the prevailing trend for outpatient surgery at our institution is to discharge children to home within 6 h, discharge times beyond 6 h would be considered for an unplanned overnight hospital admission in a h observation unit.
Therefore, the results of vomiting and recovery were analyzed in the first 6 h and beyond 6 h. The factors that contributed to the delay of discharge beyond 6 h, which included age older or younger than 6 yr , vomiting, and anesthetic technique, were explored. Parametric data were compared using a one-way analysis of variance with Bonferroni corrections for multiple comparisons between groups.
The data for discharge times showed a broad, nonGaussian distribution and were analyzed by the Kruskal-Wallis one-way analysis of variance.
Categorical data were expressed as counts and analyzed with 4 x 2 chi-square test to detect differences among the study groups.
If significant differences were found, follow-up subset analyses were done and adjusted for multiple comparisons. Fisher's exact test was used when expected frequencies were less than 5. Logistic regression analyses were conducted to explore the relation between induction and maintenance with halothane and the presence or absence of postoperative vomiting.
No significant differences were detected among the four groups in age, gender, weight, and type of surgical procedure Table 1. The differences in propofol dosing among the groups is tabulated in Table 2.
Anesthesia and surgical times were not significantly different among the four groups. However, the incidence of vomiting greater or equal to 6 h and recurrent vomiting defined as greater than two episodes was not significantly different Table 4. The results of logistic regression analysis showed that vomiting occurred 3. Table 4. Ten children received intravenous atropine, seven for bradycardia and three as an antisialogogue. All children were included in the final analysis because there were no significant differences among the groups in the number of children who received atropine.
No significant differences were detected among the groups in the number of children who received intraoperative dexamethasone, postoperative acetaminophen, or acetaminophen with codeine Table 5.
No airway complications that required emergent endotracheal extubation were noted among the groups during anesthesia. No postoperative complications of airway obstruction or primary hemorrhage occurred.
In a recent editorial, Fisher [9] defined "true" endpoints as patient satisfaction, discharge times, and unplanned admissions rather than the incidence of vomiting that he considered a "surrogate" endpoint. Further analyses of the results revealed that the main factor that delayed hospital discharge beyond 6 h was vomiting within the first 6 h.
This was probably related to mandatory oral intake and age less than 6 yr rather than due to the anesthetic technique. In other studies, researchers reached similar conclusions of postoperative vomiting resulting in unanticipated overnight admission in this patient population. In previous studies of this population, age younger than yr was associated with a higher risk of poor oral intake, fever, and dehydration, which required more than routine nursing care.
Pain, anxiety, anesthetic agents, gastric distension, and the use of premedications and perioperative narcotics have been implicated in postoperative vomiting.
Carithers et al. Your pain should lessen over time. Children might recover faster than adults. Most adults recover fully within two weeks after a tonsillectomy. However, adults may have a higher risk of experiencing complications compared to children. Adults may also experience more pain during the recovery process, which could lead to a longer recovery time.
After a tonsillectomy, specks of dark blood in your saliva or a few streaks of blood in your vomit is typical. A small amount of bleeding is also likely to happen about a week after surgery as your scabs mature and fall off. Drinking lots of fluids in the first few days after surgery is the best thing you can do to ease pain and help prevent bleeding complications. A tonsillectomy is a surgical procedure to remove the tonsils, which are located in the back of your throat. Sometimes they can become infected.
When tonsils become infected, the condition is called tonsillitis. Learn more about tonsillitis causes, diagnosis, and treatment. Is it possible for tonsils to grow back after a tonsillectomy? Find out. Researchers say children who undergo tonsillectomies have a higher risk of asthma and respiratory infections as adults. Adenoiditis is an infection in the throat. Uvula removal surgery is sometimes done to treat snoring or obstructive sleep apnea.
Learn what to expect from the procedure and how long recovery…. Tonsillectomy scabs develop on former tonsil tissue shortly following surgery. They usually fall off 7 to 10 days after surgery. We explain what to…. Your parathyroid glands regulate the amount of calcium in your blood. They sometimes need to be removed if your body is producing too much calcium…. Your thyroid gland is responsible for growth and metabolism in your body.
Here are 10 common signs and symptoms of hypothyroidism, or low thyroid…. Bladderwrack is an edible brown seaweed that has been used as a natural medicine for centuries. This article reviews the benefits, uses, and side…. Health Conditions Discover Plan Connect. Is Bleeding After Tonsillectomy Normal? Medically reviewed by Karen Gill, M. Causes Types of hemorrhage What to do When to call the doctor When to go to the ER Other complications Recovering from a tonsillectomy Typical recovery time Takeaway Overview Minor bleeding after a tonsillectomy tonsil removal may be nothing to worry about, but in some cases, bleeding could indicate a medical emergency.
Why am I bleeding after my tonsillectomy? Both the pain medicine and the anesthesia can make you a little nauseous, but medicine to prevent this is routinely given during a tonsillectomy. We may provide you with a prescription for anti-nausea medication oral or suppository to take home, especially if you are a woman, because the incidence of nausea after tonsillectomy is higher in young women.
If the pain medicine gives you side effects, you may want to take the nausea medicine before taking the pain medicine. It also helps to try to take a little soft food with your pills. You may not want to and you may forget. Dehydration makes pain and nausea worse and also just makes you feel terrible.
Make sure that you drink enough to keep your urine very pale yellow and not dark. It is helpful to drink some fluids with some sugar in them and not just water all day since your body needs some calories.
You can go days without eating, but you must drink, drink, drink. It is OK to eat soft solid food on the second or third day after tonsillectomy, but many people do not feel up to eating any solid food at all for days. That is OK, and not abnormal. You can drink enough calories and also get adequate nutrition with meal supplements like Boost or Ensure.
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