MANAGEMENT OF SECONDARY HEMORRHAGE FOLLOWING PEDIATRIC ADENOTONSILLECTOMY

A retrospective study was performed of all patients requiring admissio n to the Royal Children's Hospital, Melbourne over a 12 year period wi th secondary haemorrhage following adenotonsillectomy, to determine wh at percentage of these children received blood transfusions or were re turned to the operating room to secure hemostasis, and to identify fac tors predictive of the need for major intervention. There were 163 chi ldren who presented from 2 to 15 days following surgery. Initial manag ement in all cases was establishment of intravenous access, and 151 re ceived intravenous or oral antibiotics. One hundred and forty one were managed without the need for major intervention (87%), including five who had silver nitrate cautery to the tonsillar fossae. Major interve ntion was required in 22 cases (13%): 5 patients were returned to the operating room for hemostasis; IS received blood transfusions and 2 un derwent both. All surgery was required within 12 h of admission and al l blood transfusions within 24 h. The highest rates of major intervent ion were in those with fresh bleeding at the time of presentation (38% ) and hemoglobin levels less than 100 g/l (36%). For those requiring a dmission with secondary haemorrhage, a period of observation of 24 h w ould probably be adequate in the majority of cases to identify those c hildren who will require major intervention by surgery or transfusion. (C) 1997 Elsevier Science Ireland Ltd.