Tonsillectomy is one of the most common childhood operations. Possible postoperative complications of tonsillectomy include pain, postoperative nausea and vomiting (PONV), delay to oral intake, airway obstruction with respiratory compromise, and primary or secondary postoperative bleeding. IV Dexamethasone has been shown to decrease PONV and increase time to oral intake when given perioperatively. NSAIDs are believed by many to increase the risk of postoperative bleeding although this is controversial. A recent Cochran review showed minimal evidence for this. Additionally the application of NSAIDs was found to decrease the incidence of post-tonsillectomy PONV, presumably via a decrease in opioid administration. Primary tonsillar bleeding occurs within the first 24 hours post operatively, and usually in the first 6 hours. These are generally the more urgent. Secondary postoperative tonsil bleeds occur around 5-10 days postoperatively, when the eschar from the wound sloughs off. Either of these post tonsillectomy bleeds can present with anemia and hemodynamic compromise, and the patient should be stabilized and resuscitated if at all possible prior to returning to the OR. Respiratory complications including hypopnea, airway obstruction and death have been described after tonsillectomy and adenoidectomy. Children with severe obstructive sleep apnea are at greatest risk. Chronic airway obstruction with hypoxia (episodes of overnight oximetry < 80%) increases opioid sensitivity in children and may explain some of this risk (Brown 2006).
Karen A Brown, André Laferrière, Indrani Lakheeram, Immanuela Ravé Moss Recurrent hypoxemia in children is associated with increased analgesic sensitivity to opiates. Anesthesiology: 2006, 105(4);665-9