Tonsillectomy Surgical Information Pack

Please note that the following is a general guideline only. For a full assessment, exclusion of any other underlying cause for your symptoms and an individualised treatment approach, you will need to be seen by a qualified specialist.

1   General Pre Operative Instructions

Prior to any surgery it is important that necessary precautions are taken to minimise the risk of operative bleeding as well as general anaesthesia. Following are some important pre operative instructions.

1. If you or any blood relatives have tendency to bleed or bruise excessively, please notify the surgeon.
2. Disclose all medical illness to the surgeon and the anaesthetist.  By   doing so the doctors are able to determine your anaesthetic risk, and do appropriate pre operative investigations and optimise your  medical treatment.  If there is a need your surgeon may get other appropriate specialists involved for the pre operative work up.
3. If you are a smoker, you must stop smoking for up to two weeks prior to surgery.
4. If you take blood-thinning medications such as Warfarin, Aspirin or Newer anti platelet medications, these need to be disclosed to the    surgeon. The surgeon will ask you stop these for ten days if it is safe to do so, after consultation with your physician. He may cancel surgery if the risk of stopping such medications is too high.
5. There is potential of certain dietary supplements, including garlic, Ginkgo biloba, ginger, ginseng, glucosamine fish oil, and vitamin E, to interfere with hemostasis. These and any other supplements should also be stopped well in advance. 
6. Practical matters: Organise sufficient assistance at home. Stay with close proximity to a hospital. Ensure you have some one to drive you to emergency, incase of a bleed. Have access to a phone. Do not plan travel for at least four week following surgery. 

Please read the College of Surgeon's tonsillectomy document given. If you have any concerns, do not have this information or wish to speak to your surgeon please contact the reception.

2   Tonsillectomy/ Adenoidectomy: Post Op Instructions

1. Tonsil: PAIN:You or your child will be quite sore post operatively. Adults tend to suffer more due tonsils having been infected more. Take paracetamol every four to six hours for 10 days even if not sore. Take endone only as prescribed and ask for instructions from your nurse prior to going home. Ensure that you know how to take the correct amount. DO NOT use endone in the presence of drowsiness. Sleep Apnoea patients should not take endone at home, unless they had received the correct dose under observation in the hospital, and correct advice had been given. Adenoid surgery is usually not very sore, take paracetamol as required.
2.  EATING:One should eat normally. Eating toast, rough foods will help keep the throat clean, and reduce the chance of infection and bleeding. Do not heat hot or spicy foods. 
3. BLEEDING: Bleeding can occur up to two weeks and very rarely up to four. If there is any fresh blood dripping, or clots noted you must be admitted to hospital to be kept under observation. There is a rare risk of haemorrhage following small “warning” bleeds. Bleeding should not be taken lightly.
4. SLEEPING: Its best to sleep slightly propped up. Lying completely flat congests the throat, and can increase the chance of bleeding.
5. TRAVELLING: Stay close proximity to a hospital even up to four weeks. Generally is safe to go to school/ Work after two weeks, but NOT Camping!!
6. GENERAL ACTIVITY: I would just be sensible. Nothing too vigorous, but there is no need to spoil your child enjoying a good post operative recovery.
7. INFECTION: Surgery site will be quite yellow, and that is normal. However it is common to be given about 10 days of antibiotics.
8. HOME: You must have access to a phone and a friend to drive you to hospital in the case of haemorrhage. 
9. Monitor: i.e. Carer sleep in the same room as the patient

If Concerns
Contact surgeon, the hospital and if an emergency go to Monash or Frankston (not the Private Hospital ED) as discussed by your surgeon. 

3  Consent For Your Surgery

Informed consent is a process of finding out information about the recommended treatment, alternative options and weighing up the benefits and risks involved. It is not about just signing a form. This involves

• The diagnosis and likely outcome (prognosis) of your condition
• An explanation of the recommended treatment
• The risks of the procedure and common side effects
• Possible complications
• Specific details of the treatment; for example, where it will be performed and who will perform it
• Any other options for treatment and their probability of success.

It is not possible, however, to provide complete information or predict outcomes or assess risks with certainty; and patients need to be aware of this uncertainty.

You would also be provided with a official handout about surgery, which you will be requited to read and understand. If you have any specific matters which you like to further discuss you are requested to contact the surgeon and make another appointment prior to surgery. You have the right to cancel surgery if you wish to do so.

Summary of the risks and complications of tonsillectomy which your surgeon has discussed with you include the following

1) Pain

2) Infection

3) Bleeding

4) Rare risk of haemorrhage and need of a transfusion. 

5) Extremely rare risk   of a life threatening bleed (higher in very young children)

6) Injury to teeth and other surrounding structures

7) Altered voice

8) Altered taste

9) Rare recurrence of tonsils, adenoids

10) Risks of anesthesia: Anesthetist will discuss this on day of surgery

11) With adenoids small risk of reflux of air, food to the nose