MANAGEMENT OF TONSILLECTOMY HEMORRHAGE - RESULTS OF A SURVEY OF PEDIATRIC OTOLARYNGOLOGY FELLOWSHIP PROGRAMS

Purpose: To reach a consensus on the preoperative evaluation and manag ement of intraoperative and postoperative tonsillectomy hemorrhage. Me thod: A survey on the preoperative evaluation and the management of in traoperative and postoperative tonsillectomy hemorrhage was given to o ne of the faculty members at each of the pediatric otolaryngology fell owship programs in the United States. Results and Conclusions: Sevente en surveys were distributed with 100% response. The majority obtained preoperative laboratory evaluation. Nearly an equal number of responde nts preferred either cold or electrocautery dissection techniques, but the majority used electrocautery to control hemorrhage. After a posto perative bleeding episode, the results are as follows. (1)The majority favor admission for observation. (2) Little difference exists in the management of immediate and delayed hemorrhage. (3) When clot exists i n the tonsillar fossae, removal is recommended. (4) Approximately two thirds of respondents attempt control of active bleeding in the emerge ncy room, whereas the remaining proceed directly to the operating room . (5) After multiple episodes, a full hematologic evaluation is warran ted. (6) Age and cooperativeness of the child is an important determin ant in the decision-making process. Copyright (C) 1995 by W.B. Saunder s Company