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Changing Perspectives: Tonsillectomy and its implications for anesthetic management

Tonsillectomy and its implications for anesthetic management

Many children with complaints of upper airway obstruction undergo a tonsillectomy. Dr. Sluder (1865-1928) first described this procedure in 1911, which includes the use of a blunt guillotine.1 He was able to remove both tonsils in less than 10 seconds. General anesthesia was extremely dangerous at the time. Therefore, this technique was performed in non-intubated children, mostly with the use of local anesthetics, and sometimes without any anesthetics.

Over many years, Sluder’s method made way for a nowadays daily used dissection technique in which intubation is necessary. In this procedure, a free airway is guaranteed throughout the whole operation. Moreover, the surgeon is able to perform the tonsillectomy more carefully, and as a result the hemostasis of the operational area can be monitored more precisely. However, this technique is more cumbersome and has an increased procedural time.

Sluder’s operation is still performed in some Dutch hospitals. Current guidelines recommend that his technique should only be performed in non-intubated children by competent anesthesiologists and ENT specialists.2  The airway is considered unsafe due to the possibility of aspiration of tissue and blood. Moreover, this very painful stimulus is performed during sub-anesthetic threshold values of volatile anesthetics, which may lead to acute laryngospasm, resulting in a ‘cannot ventilate’ situation in a patient without intravenous access. In addition, anesthesiologists lose their competence as this method disappears in their education. Thus, in our opinion, the classic dissection technique is ought to replace Sluder’s operation in non-intubated children.

S. Rozemeijer & B. Bossers

References

  1. Sluder, G. A method of tonsillectomy by means of a guillotine and the alveolar eminence of the mandible. J. Am. Med. Assoc. 1911;867–871.
  2. Richtlijn ‘Ziekten van adenoïd en tonsillen in de tweede lijn’. 2014.

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