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Wednesday, January 09, 2008

Tonsillectomy - On the day of surgery he had running nose

Question

029. A 5 year old patient is scheduled for tonsillectomy. On the day of surgery he had running nose, temperature 37.5ºC and dry cough. Which of the following should be the most appropriate decision for surgery?

1. Surgery should be cancelled.

2. Can proceed for surgery if chest is clear and there is no history of asthma

3. Should get x-ray chest before proceeding for surgery

4. Cancel surgery for 3 week and patient to be on antibiotic

Answer

4. Cancel surgery for 3 week and patient to be on antibiotic

Reference

Dhingra 3rd Edition Page 490

Quality

Thinker

Status

New

QTDF

Dhingra

Discussion

Contraindications of Tonsillectomy are

  1. Hemoglobin level <>
  2. Presence of an acute infection in upper respiratory tract, even acute tonsillitis. Bleeding is more in the presence of infection
  3. Children under 3 years of age. They are at poor surgical risks
  4. Overt of submucous cleft palate
  5. Bleeding disorders
  6. At the time of epidemic of polio
  7. Uncontrolled systemic disease like diabetes, cardiac disease
  8. Tonsillectomy is avoided during the period of menses

Explanation

  1. Surgery should be cancelled and there is no doubt about that, but this is an incomplete choice
  2. Because of infection, the surgery cannot proceed even if the chest is clear
  3. There is no need to get a X-Ray as we already know that there is an infection
  4. Cancellation of surgery and starting the patient on antibiotic is the best option

Comments

Adenoidectomy was probably first performed in the late 1800s when Willhelm Meyer of Copenhagen, Denmark, proposed that adenoid vegetations were responsible for nasal symptoms and impaired hearing. However, tonsillectomy has been performed for at least 2000 years; Celsus first described the procedure as early as 50 CE. The hidden location of the adenoid certainly had an impact on the historical timing of discovery.

Tips

The 2 operations were routinely performed together beginning in the early part of the 1900s, when the tonsils and adenoids were considered reservoirs of infection that caused many different types of diseases. Tonsillectomy and adenoidectomy (T&A) was considered a treatment for anorexia, mental retardation, and enuresis or was performed simply to promote good health.

3 comments:

  1. my answer is B

    temp is 37.5-which is normal
    pt doesn't have productive cough
    has running nose but not mentioned of purulent discharge.

    all these indicate that pt is not havig infection.

    please go through Present recommendations .

    ReplyDelete
  2. //please go through Present recommendations .//

    Can you cite the relevant article please sir

    ReplyDelete
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