Anaesthetists Handbook - MEDICAL EDUCATION at University ...

ENT anaesthesiaENT anaesthesia{Dr Cyprian Mendonca and Mr Darius Rejali, July 2007; appraised byDr Mendonca, January 2010]These are guidelines for management of pain and prevention ofpostoperative nausea and vomiting in patients undergoingtonsillectomy and adenotonsillectomy.Tonsillectomy is the most commonly performed ENT procedure inchildren. There is a high incidence of postoperative pain, nausea andvomiting (as high as 54%) and post-operative pain followingtonsillectomy varies with the method of surgery, administeredanalgesics and individual patient factors. Previous audit (no. 356) hasrevealed that 37% of patients suffer from moderate pain during thepostoperative period on return to the ward. Optimising perioperativeantiemetic prophylaxis and analgesia are important factors inpreventing morbidity, prolonged hospital stay and enhancing patientsatisfaction.Paediatric tonsillectomyFor paediatric tonsillectomy, use your familiar anaesthetic techniquewith the following modifications.Preoperative• Clear fluids allowed up to two hours preoperatively (a child canhave a drink of clear fluid ~10 mL kg -1 , maximum 100 mL twohours preoperatively).• Consider premedication with paracetamol (20 mg kg -1 oral) +ibuprofen (5 mg kg -1 ).Intraoperative• Induction: propofol (or inhalational induction if indicated) +fentanyl (suggested dose is 0.5 –1.0 µg kg -1 ).• Dexamethasone 0.1 mg kg -1 (intravenous).Anaesthetists Handbook January 2010 193