General Anesthesia for a Posttonsillectomy and Adenoidectomy Bleed

Abstract

Introduction: Providers at all levels should have some understanding of the pathophysiology and be able to manage such a patient in the operating room. In addition, any anesthetists providing pediatric care should be able to identify and understand the importance of other comorbid conditions in these patients. This simulation on posttonsillectomy and adenoidectomy hemorrhage in the pediatric patient presents a challenging case usually encountered in some form by most anesthesia residents during training. This simulation's objective is to challenge and further reinforce the knowledge of anesthesiology resident physicians who have completed 1 year of clinical anesthesia and at least 1 month of pediatric anesthesia. Methods: The simulation can be delivered in a single session of 1 hour or less. Materials in this simulation include a case template designed to provide facilitators with a general overview, a checklist of critical actions each learner should perform during the scenario, a brief summary to be provided to the learner to reinforce knowledge gained through the activity, and an evaluation form to assess the learner's view of the activity's educational value. Results: Learner comments were almost unanimously positive. All learners who returned surveys answered the questions "This simulation enhanced my understanding of how to manage critically ill patients in the perioperative period" and "The content was current and relevant to my practice" with either agree or strongly agree. Discussion: The module offers various points to practice troubleshooting skills in the management of difficult IV line placement as well as difficult airway management. In reality, this case could be modified in multiple ways, including management of a more severe hemorrhage with a much more hypovolemic patient.

Pediatric Anesthesia Management for Post-Tonsillectomy Bleed: Current Status and Future Directions

“…Aside from short papers or sections in manuscripts on otolaryngologic emergencies [10][11][12][13]18 and a single center study from 1973, 14 only three recent papers have examined PTH and anesthesia. In particular, an anesthesiology education article on simulation training 15 and two single center retrospective studies have focused on the anesthetic management of PTH patients. 16,17 Anesthesia considerations at various phases of care in this patient population will be discussed to include preoperative preparation, induction techniques and future directions (Table 1).…”

“…30 Simulation can be another useful educational tool for reinforcing these techniques in a PTH scenario and in trouble-shooting challenges that may arise such as difficult intravenous access. 15 Timely utilization of ultrasound guidance to assist in peripheral intravenous access when it proves challenging and facility in using the infrequently utilized intraosseous access may save valuable time in definitively treating PTH. 31,32 Nonsteroidal Anti-Inflammatory Drugs…”