Large Post-tonsillectomy Thrombus Obstruction of Laryngeal View: Management Approach

Recently published paper discusses the challenges of managing pediatric patients with post-tonsillectomy hemorrhage, particularly when obstructive clots interfere with the laryngoscopic view during intubation. Tonsillectomy is a common pediatric surgery, and post-tonsillectomy hemorrhage occurs in 2.9-5% of cases, often requiring a return to the operating room. The anesthetic challenges in these cases are due to potential anemia, hypovolemia, and an increased risk of difficult airway. The difficulty of intubation is further exacerbated by active bleeding, vomiting, and pharyngeal clots. The paper presents a case of a 13-year-old female who presented with post-tonsillectomy hemorrhage and a large obstructing clot. The anesthetic team successfully managed the airway using a four-hand technique, involving the use of Magill forceps and suction to remove the clot and secure the airway with an endotracheal tube during rapid sequence induction.

Techniques and Considerations in Anesthetic Approach for Post-Tonsillectomy Hemorrhage

The paper highlights the rarity but significant challenges associated with post-tonsillectomy hemorrhage and the need for a well-prepared anesthetic approach in such cases. It describes the specific techniques and equipment utilized in the presented case, emphasizing the importance of a coordinated team approach and the availability of appropriate instruments for prompt clot removal and intubation. The authors also discuss the potential risks and considerations in airway management for patients with post-tonsillectomy hemorrhage, including the presence of obstructing clots, active bleeding, and newly difficult airway compared to the initial tonsillectomy surgery.

Insights into Anesthetic Management of Pediatric Patients with Post-Tonsillectomy Hemorrhage

In conclusion, the paper provides valuable insights into the anesthetic management of pediatric patients with post-tonsillectomy hemorrhage and obstructing clots obstructing the laryngoscopic view. The described four-hand technique for intubation in such cases offers a practical approach to addressing the specific challenges posed by pharyngeal clots. The paper emphasizes the importance of preparedness, appropriate equipment, and a coordinated team effort in ensuring successful airway management in these challenging situations.

Reference -

Tamraz R, Austin R, Falcon R, et al. (October 09, 2023) Management of a Large Post-tonsillectomy Thrombus Obstructing the Laryngeal View: A Case Report. Cureus 15(10): e46763. doi:10.7759/cureus.46763