Operation to remove adenoids under anesthesia: types, how long lasts

When adults get sick, it's bad, but when it comes to a child, it's hard for the kid himself and his parents. How many worries and worries bring children's illnesses to adults. Here, for example, adenoids, which are growths on the tonsils, diagnosed mainly in children under 12 years. These formations, consisting of lymphoid tissue, as they grow, create noticeable problems for the child, so at some point they are talking about their removal (adenectomy). And since, adenectomy is a surgical operation, removal of adenoids under anesthesia is considered a common practice, which prevents various complications during and after surgery.

In principle, anesthesia during surgery on the tissues of the body seems quite logical. But on the other hand, parents, worried about the very idea of a surgical operation in a child, especially acutely perceive the idea of injecting a baby with anesthesia, which even in adults often causes unpleasant, and in some cases dangerous symptoms. In connection with these parents have many questions. Is it possible to do during an operation without anesthesia, as it did in the old days? How justified is the use of anesthetics during the removal of adenoids? And whether it is necessary to carry out in general a resection of adenoids, traumatizing the psyche of the child, if the probability of recurrence of the disease does not exclude the procedure?

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Adenoids: what is it and do I need to delete them?

Adenoids (or tonsils) are sprouting of lymphoid tissue on the surface of the tonsils. Lymphoid tissue in itself is designed to delay the infectious factor in the upper respiratory tract, not allowing it to sink lower, irritating the bronchi and lungs and causing inflammation in them. Adenoids are also associated with the formation of strong immunity.

Removing tonsils, a person deprives himself of protection. But on the other hand, if the lymphoid tissue is inflamed due to frequent catarrhal diseases (adenoiditis), this indicates that she herself is now the source of infection.

Yes, inflammation can be fought, but not always it gives good results. At some point, a chronic inflammatory process can lead to a pathological proliferation of tissues (hyperplasia), which, increasing in size, will overlap the nasal passages adjacent to the back wall of the pharynx.

It is clear that the proliferation of adenoids to a critical condition, when they block the way to air moving through the nasal passages, and almost completely block the nasal breathing, occurs not in a single day. The process develops gradually, passing in its development 3 (and according to some sources 4) stages.

About adenoids 1 degree, they say, if the lymphoid tissue above the tonsils covers not more than 1/3 of the space of the nasal passages on the posterior wall of the pharynx. At 2 degrees of adenoids, pathological growths overlap nasal breathing already half or slightly more.

This state of affairs allows the child to breathe through the nose, but it becomes more difficult to do this. If in the first stage the baby breathes normally during the day, and problems with nasal breathing begin at night only (in a horizontal position, during sleep), as indicated by partial nasal congestion, snoring, restless sleep, etc. The second stage is characterized by problems with breathing through the nose even in the daytime. At night, the baby snores clearly, and in the afternoon tries to keep the mouth open so that air can enter the lungs through it. Attempts to breathe through the nose are becoming more difficult, accompanied by a loud breath and exhalation.

And yet in the first two stages, at least some possibility to breathe normally through the nose remains, which can not be said about the third degree of adenoids, when hypertrophic lymphoid tissue covers the nasal passages inside the pharynx almost completely. Now breathing with the mouth for the child becomes a vital necessity. Breathing with a closed mouth becomes impossible, which means that the baby does not cover the mouth at all, which contributes to the formation of a specific elongated shape of the face with a smoothed nasolabial triangle (adenoid face).

But this is not the worst. The child's voice changes (becomes hoarse, nasal), problems with appetite begin, and, accordingly, with the digestive system, sleep is disturbed, which affects the general condition and physical activity, hearing worsens due to adenoid occlusion of the Eustachian tube located nearby and development in it inflammatory process.

Due to a lack of oxygen (lack of full breathing, especially at night), cognitive processes and mental abilities deteriorate (memory and attention suffer primarily), and progress in learning outcomes is reduced. It would seem that a completely healthy child begins to lag behind in development.

Change in appearance and voice affects the attitude of the child to his peers. After all, children are cruel, not realizing the consequences of their evil jokes and support. A child who has not been treated or treated with adenoids at the time begins psychological problems (depressive conditions, isolation, difficulties in establishing contact, etc.).

Removal of adenoids under anesthesia or without anesthesia is a risk to remain unprotected, which means that the infection, getting into the upper respiratory tract, will be able to go unhindered further into the broncho-pulmonary system. But if you do not, the consequences look even more sad.

In addition, the function of delaying dust, bacteria and viruses is peculiar not only to the adenoids, but also to the nose, for which there are special villi within the nasal passages. If the child begins to breathe through the mouth, the air does not pass through the nasal passages and does not receive sufficient cleaning and moistening. Inflamed adenoids are not capable of performing a protective function, which means that the respiratory system again remains unprotected.

The absence of nasal breathing due to the proliferation of lymphoid tissue is an indication for the appointment of an operation to remove adenoids. With adenoids of the 3rd degree, the question of conservative treatment no longer rises. Only the operation can help the child, parents want it or do not want it. Treatment of adenoiditis and its consequences is necessary in the first two stages. And to recognize the disease on time, you need to be attentive to your child, noting all the suspicious symptoms and consulting about their occurrence with a pediatrician and an otolaryngologist.

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Surgery for the removal of adenoids and its types

Removal of adenoids or adenoectomy, despite all the ease of carrying out, is considered a serious surgical operation, the need for which arises mainly with the third degree of adenoids. However, in some cases, the operation can be performed earlier, without tormenting the child with prolonged conservative treatment. To remove adenoids resorted and in the absence of improvement after the course of medication and physiotherapy.

Determine the degree of adenoids only on symptoms from the words of parents and the baby is very difficult. Symptoms of all 3 degrees intersect, and the baby can begin to breathe with the mouth even in the initial stage of adenoiditis, if the nasal tissues become swollen and cause a feeling of congestion. An external examination of the throat with a flashlight also does not provide enough information, so doctors resort to more informative methods of diagnosing enlarged adenoids:

• Study of the nasopharynx with a finger (palpation of adenoids),
• The study of the state of lymphoid tissue over the tonsils by means of a deeply inserted mirror in the oral cavity (posterior rhinoscopy)
• X-ray examination of the nasopharynx and accessory sinuses,
• Diagnostic endoscopy (investigation of the area of adenoids proliferation with the help of a fibroscope inserted into the nasal passages from the outside).

In the case of diagnosing the third degree of adenoids, the child is sent for surgery to remove them. The procedure for resection of glands can be carried out by various methods.

The first and somewhat outdated method of adenectomy is the manual removal of adenoids. In fact, the operation uses a special knife - an adenotome in the form of a loop with sharp edges, by means of which the expanded tissue is simply cut from the surface of unchanged mucosa.

Despite significant shortcomings (rather severe bleeding during the operation and the inability to visually assess the quality of the work), in some clinics adenectomy continues to be carried out by the ancient method to this day.

By the way, it is this type of surgery that often has complicated complications in the form of repeated proliferation of lymphoid tissue in the event that a small part of it has not been removed while working with the adenotome. The doctor can not see if all the tissues have been removed completely, since the operation is practically carried out.

In the old days, when the traditional method of manual removal of adenoids was the only method of fighting the disease, the operation was performed without anesthesia. Mom and grandmother of today's kids (as well as male relatives) may still remember that "horror" from the sight of the blood flowing from the mouth, which overpowered even painful sensations. Maybe that's why they are so worried about their children and grandchildren who will have an operation to remove tonsils.

To date, parents have a choice, because there is a sufficient number of new, more effective and perfect methods of removing adenoids:

• endoscopic (the operation is carried out under the control of the endoscope and the procedure, as well as the quality of removal of lymphoid tissue can be monitored by a computer on whose monitor the image of the mini-camera at the end of the fibroscope passes)
• electrocoagulation (cauterization of tissues by electric current),
• laser coagulation (with a laser beam of a certain intensity, pathologically altered tissues are removed and immediately cauterized, which avoids bleeding, the beam passes to a greater depth, which avoids the recurrence of the disease and infection of the wound)
• cryodestruction (freezing tissues with liquid nitrogen, as a result of which they die painlessly and bloodlessly and are removed).

Innovative methods have a much lower percentage of complications, while the removal of adenoids for today is mainly carried out under anesthesia. So the child does not feel pain and discomfort during the operation, and does not experience those feelings and emotions that have been deposited in the memory of their parents and other long-grown relatives for a long time.

The times of adenectomy without anesthesia have irretrievably gone, but at the insistence of parents anesthesia to the child before the operation may not be introduced. In principle, the choice is always for the parents: to agree to anesthesia or not, and if you do an operation under anesthesia, what kind of anesthesia to choose.

Types of anesthesia in the removal of adenoids

So we came to the main issue, which worries many parents whose children will have adenectomy. Under what anesthesia are the adenoids removed? By what principle can this or that type of anesthesia be prescribed? Why do modern doctors tend to remove adenoids under anesthesia, if earlier this operation was successfully carried out without the introduction of painkillers?

To begin with, during an adenectomy, doctors can use 2 types of anesthesia: local and general. In domestic clinics most often conduct local anesthesia, while abroad it has long been accepted to remove adenoids under general anesthesia. However, anesthesia (and even more general) does not suit all children, in this case, the operation is performed either without any anesthesia, or using local anesthetic agents that do not require intravenous administration, but are applied directly to the mucous membrane in the region of the posterior pharyngeal and tonsils.

Strange as it may seem, in the memoirs of adults who in the past removed adenoids (naturally without anesthesia), there is practically no mention of a strong pain, but it is a question of excision of living tissues. The cause of loss in memories of such a symptom is his complete or partial absence. The fact is that the lymphoid tissue practically does not contain nerve endings, due to which we feel pain, heat, cold and other tactile sensations.

Due to the lack of sensitivity of the adenoid tissues, surgery for removal is considered almost painless. It becomes incomprehensible question, why do doctors in this case insist on anesthesia?

The reason for such perseverance of doctors is not at all the desire to "knock down" patients from more money (anesthesia still requires a separate payment). It has psychological reasons. After all, how many children do not tune in that it will not hurt, the kind of instruments used in surgery and the "white coat" syndrome will still catch up with fear. And the closer the doctor approaches, the more the child will want to cry, scream or even escape from the "tormentor".

The slightest careless action of the surgeon and the nearby tissues that have much more nerve endings can be affected. Their damage is unlikely to cause much harm to the baby, but the pain can be quite strong. Will the baby continue to sit quietly during the operation in such conditions?

Even minor pain sensations will seem more tangible if they are supported by the contemplation of the kind of their own blood. And it is not known what traumatizes the psyche of the child: pain or type of blood. In many cases, blood is even more irritating than pain, causing a person to feel fear for their lives.

If we have dealt with the necessity and use of anesthesia, the question of which anesthesia to choose for your baby remains open. Many modern clinics and medical centers of our country already today can offer a choice: to perform an operation under general anesthesia or to restrict oneself to the use of local anesthetics. It remains only to determine the type of anesthesia.

What anesthesia to choose?

We are all parents, and we wish our children only the best. Everyone wants an operation to remove the adenoids from his child was successful, and the child did not experience discomfort and pain, which the adults know not by hearsay. What do you need to rely on, determined with the type of anesthesia on the eve of the removal of adenoids under anesthesia?

Undoubtedly, when talking about children, the safety of the procedure of anesthesia for the health and life of a little man comes to the fore. It is clear that any anesthetic, getting into the blood or into the human respiratory system, will cause harm more than a local remedy that is absorbed into the blood in smaller amounts. Removal of adenoids under local anesthesia implies the application of anesthetic agents to tissues that will subsequently be removed and the surrounding area. This significantly reduces the sensitivity of the mucosa, and with qualitatively conducted anesthesia, there is no discomfort and pain during surgery, the baby does not experience.

Local anesthesia can be carried out with the help of inhalation products, produced in the form of sprays, to treat the surface of the pharynx with solutions of anesthetics (for example, lidocaine, tylenol, etc.) or dig in their nasal passages. Intravenous and intramuscular injections of anesthetics in the practice of adenoid removal in children are not used.

The advantage of local anesthesia can be considered the possibility of performing surgery in outpatient settings, as special equipment is not required in this case. After the procedure, the child can immediately go home. Special monitoring of it, as in the case of general anesthesia, is not required.

A major drawback of local anesthesia is the ability to see the course of the operation, because the baby is still conscious. No, the child does not feel pain. Even if the anesthesia is performed poorly, minor painful sensations occur only in the case of damage to nearby healthy tissues, there are no nerve endings in the lymphoid tissue. But how to make a child with curiosity curious enough to close his eyes and switch to pleasant thoughts if around him people scurry around in white coats and try to take something out of his mouth that he did not even see.

Natural curiosity leads to the fact that the child can see gushing from the mouth of the blood (especially in the case of the classical manual method of adonectomy) and get very frightened even though pain will not be felt. This can negatively affect the outcome of the operation. The child will cry, try to dodge, and the doctor can not qualitatively remove all the particles of enlarged lymphoid tissue.

The baby can be persuaded that there will be no pain, but the fear of people wearing white coats that once hurt him during blood sampling, vaccination, medical procedures, and before surgical instruments with local anesthesia will not disappear anywhere.

It is this psychological factor that opposes local anesthesia. But it allows you to bypass the general anesthesia, which is considered preferable during adenomectomy. But general anesthesia, as everyone understands, is considered less safe, even though modern anesthetics have significantly fewer contraindications and side effects than previously used drugs.

It's time to consider all the advantages and disadvantages of general anesthesia, and to figure out how to do so that an effective procedure of anesthesia, allowing to carry out the operation at a high level, does not harm the child.

Removal of adenoids under general anesthesia

When there is a question of choosing anesthesia, I want to get as much information about each method of anesthesia. Having dealt with the features of the application, as well as with the advantages and disadvantages of local anesthesia, it's time to get information about the general anesthesia popular both abroad and in domestic advanced clinics.

We begin, as is customary, with the advantages of this method. The main advantage of general anesthesia is the physical and moral calmness of the child during the operation. At the time of removal of adenoids, the baby is already unconscious, which means that it can not see or hear what is happening. Even if there are any complications (for example, severe bleeding or damage to the healthy mucosa accompanied by pain), the small patient will not know about it. When he comes to, the operation will be over.

The next important advantage is the patient's calmness during adenomectomy, because he will not have to be distracted by the reaction of a child, which is almost impossible to predict. The surgeon can calmly do his job, slowly withdrawing clusters of lymphoid tissue, leaving her unable to recall her again.

General anesthesia in the removal of adenoids in children can significantly reduce the time of surgery, because the doctor does not have to stop every time the child begins to worry, cry, twitch. It does not take time to calm a small patient.

Removal of adenoids under general anesthesia with the use of modern inhalation anesthetics, doctors consider the safest method to prevent such an unpleasant complication as a re-increase in the volume of lymphoid tissue. In addition, such an anesthesia protects the child's psyche, which is also important, because a strong nervous shock can cause fluctuations in blood pressure, heart rhythm disturbances, shock conditions regardless of the patient's age.

Advantages of general anesthesia can be considered absolute absence of pain (with local anesthesia it is more difficult to achieve this), prevention of the risk of respiratory tract particles getting removed, relatively low risk of bleeding from damaged tissues (if the child begins to actively move, resisting the actions of the doctor, and crying, the probability bleeding increases, as does the risk of damage to healthy tissues).

If the bleeding does take place, the doctor can calmly evaluate the result of the operation and conduct measures to stop the blood (this is usually done with a tamponade of the nose using hemostatic drugs). Carrying out such manipulations with a crying child is quite problematic, as well as correcting shortcomings.

But in addition to the positive aspects of general anesthesia, there are some disadvantages:

• there is a small chance of developing nasal bleeding, not associated with the removal of glands,
• fluctuations in body temperature are possible, which requires the supervision of a doctor,
• there is a minimal risk of complications such as hearing impairment, sleep and speech disorders, migraines (usually such symptoms are temporary),
• a longer, hard (not always) period of withdrawal from anesthesia,
• quite a decent list of contraindications.

It is worth saying that general anesthesia is most preferable in children with an unbalanced temperament. It is prescribed for intolerance of analgesics used for local anesthesia, and also if the anatomical structure of the pharynx and the location of the adenoids require a special approach to the operation, and surgical intervention can be delayed.

But let's return to contraindications, which do not allow performing adenoids removal under general anesthesia. To this type of anesthesia do not resort, if:

• acute infectious pathologies occur (due to the risk of spreading the process),
• there are diseases of the upper or lower respiratory tract (in particular, with bronchial asthma),
• the child is diagnosed with rickets / hypotrophy,
• on the skin of the baby, purulent eruptions have been found,
• the child has an increased body temperature for unknown reasons,
• the patient suffers from mental disorders,
• there are exacerbations of chronic diseases,
• the child has heart problems that are not amenable to treatment (if there is an opportunity to stabilize the child's condition, the operation is performed after the end of treatment and usually under local anesthesia).
• the baby was vaccinated the day before (the operation is performed no earlier than 2 weeks after the introduction of the vaccine).

If there are acute pathologies, the operation using general anesthesia is performed after complete recovery or remission (in case of chronic diseases). When intolerant inhalation anesthetics are used for general anesthesia, the operation is done without anesthesia or using local medications.

Due to the fact that general anesthesia has a large number of contraindications and possible side effects (most often nausea, vomiting, dizziness), before it is carried out, the child is examined by an anesthetist and, if possible, an examination of the medical history, including a certificate of vaccination, or the words of the parents . The doctor finds out whether the child has had allergic reactions to medications and which drugs caused such manifestations. It is mandatory to conduct clinical studies, including blood and urine tests, blood coagulability indicators, electrocardiogram.

Parents and children are warned that on the eve of the operation, food can not be consumed. The kid can have dinner at about 7 pm, but he will not have to eat breakfast. Drinking water on the day of surgery is also not recommended (at least 3 hours before the procedure for removing adenoids).

As a preparation for surgery from the evening and on the eve of the procedure (usually one hour before surgery), the child is given sedatives, preferably of vegetable origin. Immediately before the operation, an enema is made and asked to empty the bladder.

To reduce the negative effects of anesthetics for general anesthesia, a child is injected with drugs "Promedol" or "Atropine." Before doing general or local anesthesia, the child and parents explain what and why the anesthesiologist will do and what kind of sensations the baby should have.

For the operation of adenomectomy, both endotracheal and laryngeal anesthesia are suitable. The second is less common, since it somewhat restricts the surgeon's activity in the head region, moreover, this kind of anesthesia is associated with the risk of getting into the respiratory tract of pieces of excised adenoids.

Endotracheal anesthesia in adenoids makes children much more often. And although this kind of anesthesia is associated with some discomfort, and the duration of it is longer, but asphyxia during surgery is virtually eliminated.

To carry out intubation anesthesia, use not a respiratory mask, but a special intubation tube, through which the smallest particles of drugs that can cause complete relaxation and medical sleep enter the baby's respiratory system. So during the operation the child quietly sleeps and does not perceive what is happening to it.

The operation to remove adenoids under anesthesia lasts about 20-30 minutes. The dose and type of anesthetics are selected in such a way that the child wakes up after the end of the operation. The operation is considered completed after the bleeding has stopped.

At the end of the procedure the child is woken and taken to the ward, where he will come to himself within 1.5-2 hours. All this time the anesthesiologist controls the condition of the small patient. His work ends when the baby comes to his senses, but the child remains under the supervision of doctors for 2-3 hours, after which he can safely go home.

Aftercare

As the baby leaves the anesthesia, it can be nauseated and vomited with an admixture of bile. These are the side effects of general anesthesia, however, one must take into account that their intensity after endotracheal anesthesia is significantly lower than after intravenous administration of the drug. And the negative impact of anesthesia on the body in this case is less.

For some time after the procedure the child will be sluggish and weakened, so at this time you need to limit physical activity. If the removal of adenoids passed without anesthesia, in addition to fatigue, the child is unlikely to experience any more discomfort, except that as a result of the reflex edema of the mucous nasopharynx for 1-1.5 weeks, he will have a spout. Help in this case, vasoconstricting drops and sprays, the treatment which must be at least 5 days.

If the child has a fever in the postoperative period, a discomfort and a slight soreness in the throat, a suppository or a paracetamol-based syrup that will relieve fever and pain will help.

You can eat a child not earlier than 2 hours after the operation, but it's better to wait a little longer. During the first 2 weeks, it is recommended to follow a diet that provides for the exclusion from the diet of hot, spicy, acidic, salty foods because of their irritating effect on edematous mucosa.

Within a few days the doctor will recommend replacing hot baths with a warm shower, and taking walks away from crowded places where there is a possibility of spreading the infection. In the kindergarten the child can go 2-3 weeks after the operation, visit the pool - not earlier than a month. Active physical activity and physical training in the postoperative period are undesirable. The main conditions for rapid recovery: high-calorie, rich in vitamins, quiet walks in the fresh air away from roads and public institutions, full rest and sleep.

Possible complications after adenomectomy, such as bleeding or re-growth of lymphoid tissue, are most often the result of refusal of anesthesia or the use of local remedies, when the child simply does not allow the doctor to do his job qualitatively. Removal of adenoids under general anesthesia avoids such complications and makes the operation almost imperceptible for the child. Parents can be sure that their child will not subsequently have the same unpleasant memories that for a long time tormented them and caused unnecessary anxiety in the present.

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