Anesthetic management of the pediatric bleeding tonsil

Anesthetic management of the child with post-tonsillectomy hemorrhage is challenging and fraught with hazards such as anemia, hypovolemia, and risk of difficult airway. The aim of this retrospective cohort study was to determine the incidence and further define the anesthetic complications in this population.

Retrospective cohort study of all children who underwent operative intervention for post-tonsillectomy hemorrhage (with or without adenoidectomy) from 1998 to 2005 at The Children's Hospital of Philadelphia. Anesthetic records were examined for independent (anesthetic techniques and patient characteristics) and dependent variables (ventilatory and hemodynamic complications).

Four hundred and seventy-five patients required surgery for exploration of post-tonsillectomy hemorrhage (incidence 2.9%). Intravenous rapid sequence induction was used in 401 (84.4%) patients. Succinylcholine was used in 420 (88%) patients. The most common adverse event (9.9%) was hypoxemia; most episodes occurred during emergence or extubation. Bradycardia during anesthetic induction occurred in 20 (4.2%) patients, and hypotension was noted in 12 (2.5%) patients. Thirteen (2.7%) patients were noted to be difficult to intubate, none of whom were difficult to intubate during the initial tonsillectomy.

We determined our incidence of ventilatory and hemodynamic complications in a relatively large cohort of children with post-tonsillectomy hemorrhage. Transient hypoxemia was the most common complication and was not related to difficult intubation.