Anesthesia for Tonsilectomy and Adenoidectomy

[Masseter Spasm]

What anesthetic plan do you seasoned and efficient attendings use for T&A's in a surgery center environment?

Which narcotic? what dose? No Narcotic?
LMA instead of ETT?
Muscle Relaxant for case?
Extubate in PACU or OR?
Pre-op sedation?

My current regimen (suitable for the hospital setting):
PO Versed or Parent present for induction
Mask induction with Sevo
PIV then 3-4 mg/kg of propofol for intubation
No muscle relaxant
Morphine 0.05-0.1 mg/kg or Fentanyl 1-2 mcg/kg
Sevo/Des and Nitrous for maintenance
Encourage spontaneous ventilation early in case
Extubate awake in OR
This works great in the hospital but I suspect will annoy the surgeons in an ASC. Please help, looking for suggestions from those who have done several thousand of these cases.

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[jwk]

What anesthetic plan do you seasoned and efficient attendings use for T&A's in a surgery center environment?

Which narcotic? what dose? No Narcotic?
LMA instead of ETT?
Muscle Relaxant for case?
Extubate in PACU or OR?
Pre-op sedation?

My current regimen (suitable for the hospital setting):
PO Versed or Parent present for induction
Mask induction with Sevo
PIV then 3-4 mg/kg of propofol for intubation
No muscle relaxant
Morphine 0.05-0.1 mg/kg or Fentanyl 1-2 mcg/kg
Sevo/Des and Nitrous for maintenance
Encourage spontaneous ventilation early in case
Extubate awake in OR
This works great in the hospital but I suspect will annoy the surgeons in an ASC. Please help, looking for suggestions from those who have done several thousand of these cases.

Versed PO - parents NEVER in the OR (another debate another time)
Sevo induction - get em deep quickly
IV placed
Lidocaine 2+mg/kg IV for ETT
No NMB
No narcs - tylenol suppository while asleep - Sevo/N2O maintenance
Should already be breathing (no narcs)
Keep em deep - do not attempt to lighten up towards the end
Your surgeon should have them nice and dry - ETT out with the mouth gag
Evil gases off - move to stretcher and turn on their side
Make sure you're happy with A/W and off to PACU.

 

[sevoflurane]

I do pretty much the same + decadron and zofran and 1mcg/kg of fentanyl right after the IV is taped in. As soon as the first tonil is out I start to wake them up SV. I don't use N2O. Suck out the stomach as soon as I have access to airway or ask the ENT guy to do it as blood in to stomach causes N/V. Extubate deep.

 

[Arch Guillotti]

dude try a search................

http://forums.studentdoctor.net/showthread.php?t=323621&highlight=tonsils

http://forums.studentdoctor.net/showthread.php?t=586396&highlight=tonsils

 

[Planktonmd]

Versed PO - parents NEVER in the OR (another debate another time)
Sevo induction - get em deep quickly
IV placed
Lidocaine 2+mg/kg IV for ETT
No NMB
No narcs - tylenol suppository while asleep - Sevo/N2O maintenance
Should already be breathing (no narcs)
Keep em deep - do not attempt to lighten up towards the end
Your surgeon should have them nice and try - ETT out with the mouth gag
Evil gases off - move to stretcher and turn on their side
Make sure you're happy with A/W and off to PACU.

Very nice 👍

 

[Laurel123]

I rarely use PO versed. Only if the kid is being crazy or having insane separation anxiety.
In OR without parents.
Mask sevo induction.
IV in.
3-4 mg/kg of propofol with a little lidocaine.
Intubate.
Crank up the sevo, but ventilate at a slow rate to allow kid to start breathing spontaneously.
1mcg/kg of fentanyl. Decadron usually. Maintain with sevo and 100 percent oxygen. Nitrous is probably fine, but I have been pregnant, so I stopped using nitrous in my practice and just haven't started using it again.
Surgery done, airway nice and dry, gas off, tube out and mask on with good jaw lift. If the kid has a good respiratory pattern, then i pop on a transport mask and turn him on his side and send him on his way to PACU.
We can usually get 8 of these done by noon.

 

[periopdoc]

I do it pretty much like JWK.

Oral tylenol premed if patient cooperative. Rectal suppository once asleep if not.
iPhone playing age appropriate movie for sedation
Sevo induction - no nitrous why worry about the theoretical possibility of diffusion hypoxia since I am extubating deep
IV
Lidocaine + propofol IV for ETT
No NMB
No narcs
Should already be breathing
Keep em deep
Ondansetron except for the one surgeon that doesn't want any antiemetics given
ETT out with the mouth gag
Move to stretcher and turn on their side
Make sure you're happy with A/W and off to PACU.
Morphine in PACU PRN
Repeat

- pod