Paediatric Anaesthesia Department

Guidelines for the Management of the Bleeding Tonsil

1. Define the disease

1 - 2 % tonsilectomies have post operative bleed
Potentially fatal complication
Hazardous anaesthetic

2. Anaesthetic problem

Hypovolaemia
Full stomach
Bleeding in upper airway
Previous recent anaesthetic

3. Assessment of the patient

History from notes, patient, parents, nurse (esp. swallowing in children)
Observations
Examination

4. Prepare and resuscitate

Intravenous access
Blood for crossmatch and coagulation
Resuscitate with crystalloid, plasma or blood

5. Prepare theatre, staff and equipment

After resuscitation, proceed to Operating Room
Check anaesthetic machine
Instruct anaesthetic assistant, ensure they know what is needed
2 laryngoscopes, 2 functioning suckers, Magill forceps

6. Induction

Supine position, apply monitors
Take care of anaesthetic problems described above
Pre-oxygenate, rapid sequence induction in supine position
Secure airway

7. Maintenance

Intermittent Positive Pressure Ventilation
Non depolarising muscle relaxant, volatile, opioid analgesia
Large bore orogastric tube to empty stomach

8. Emergence

Antagonise muscle relaxant
Extubate awake, on side

9. Recovery

Oxygen
Maintain IV fluids
Continue monitoring

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