Tonsillectomy with and without adenoidectomy is one of the most common surgical procedures performed in the United States. 21 It is estimated that 750,000 tonsillectomies with or without adenoidectomies are performed annually.22 Since this surgery has become an outpatient procedure, complications that were previously evident in the hospital are now presenting to the emergency department. Postoperative bleeding is a well-known complication that can lead to death from airway obstruction or hemorrhagic shock. Estimates of the incidence of posttonsillectomy hemorrhage range from 1 to 10 percent. 2123
Classically, hemorrhage occurs between 5 and 10 days postoperatively, but it has been seen as late as 6 weeks postoperatively. 24 There is a significantly higher of incidence of bleeding in the age group between 16 and 25 years of age, with males having a slightly higher predominance than females. 2 ,26 Hemhorrhage is rare in children under 3 years of age.27
Emergency management of posttonsillectomy bleeding consists of ensuring an adequate airway and controlling the bleeding. Otolaryngologic consultation is necessary. Massive bleeding is rare. However, when it occurs, intubation may be the only means of protecting the airway. Each patient should be placed on a monitor, intravenous access should be obtained, blood should be typed and crossmatched, and direct pressure should be applied to the bleeding tonsillar bed while otolaryngologic consultation is obtained. Significant bleeding typically comes from a specific vessel, while generalized oozing comes from the tonsillar bed. More commonly, patients present with bleeding that can be controlled by silver nitrate, electric cautery, or direct pressure with ringed forceps, oxidized cellulose, thrombin packs, or gauze moistened with an equivolume solution of 1:1000 epinephrine and 1% lidocaine. If direct pressure fails, local infiltration of 1 to 3 mL 1% lidocaine with 1:1000 epinephrine may be attempted until the otolaryngologist arrives.
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