Removal of adenoids in children: what anesthesia is better?

The first surgical treatment of inflamed tonsils was performed at the end of the 19th century. At that time, anesthesia was not used, so the patient fully felt and observed all the features of such therapy. Today, the operation is performed under anesthesia: local or general.

In most cases, adenoid removal in children is performed under general anesthesia. Despite the fact that this type of anesthesia is associated with certain risks and side effects, modern treatment methods allow eliminating such risks in 99% of cases.

Advantages of adenotomy under anesthesia:

• Absolutely painless.
• Elimination of trauma to the psyche of the little patient and absence of resistance on his part.
• Minimal risks of inhalation of removed tissues.
• High-quality completion of the procedure: comprehensive examination and tamponade.

Let's look at the main types of anesthesia:

1. Local anesthesia – when choosing this method, the doctor takes into account the pain threshold, psycho-emotional state and age of the patient. Most often, local anesthesia is used for older children. The doctor sprays or lubricates the mucous membranes of the nasopharynx with an anesthetic.

During the procedure, the patient does not feel pain, but may be frightened by medical manipulations or the sight of blood. Therefore, local anesthesia is combined with intramuscular administration of sedatives. The peculiarity of such anesthesia is its low cost, the absence of complications and side effects. Local anesthesia is used only when parents are confident in the endurance and steadfast character of their child.

2. General anesthesia is the most popular type of pain relief. It spares the psyche of the young patient and creates favorable conditions for the operation. Since the baby is unconscious, the doctor has the opportunity to completely remove the adenoid tissue. This type of anesthesia has certain risks and complications.

The decision on the method of anesthesia is made by the anesthesiologist after studying the main health indicators and the severity of the inflammation. Particular attention is paid to the risk of developing allergic reactions to the anesthetics used. Removal of adenoids in children under 7 years old is performed only under general anesthesia; for older patients, local anesthesia may be used. As for the side effects of anesthesia, they are temporary and develop in 1% of patients. Most often, patients experience the following symptoms: drowsiness, nausea and vomiting, nosebleeds.

Removal of adenoids in children under general anesthesia

In most cases, adenoid removal in children is performed under general anesthesia. This is due to the fact that local anesthesia is very difficult to perform efficiently so that the patient does not experience discomfort.

After intravenous administration of the anesthetic, the patient's mouth is opened with a special instrument and the selected surgical method is used. The patient is unconscious for 30 minutes. Recovery from anesthesia is long and accompanied by unpleasant sensations. Side effects may develop.

Advantages of general anesthesia:

• No pain during the procedure.
• Reducing the risk of psychological problems after surgery.
• Low risk of developing postoperative complications.
• Removal takes no more than 30 minutes.

As for the disadvantages, they include a 1% risk of complications, which manifest themselves in the form of nosebleeds. The risk of developing infectious consequences, damage to teeth or aspiration is minimized. In some cases, problems with maintaining a stable body temperature, i.e. hyperthermia, arise.

Immediately after recovery from anesthesia, the child may experience hearing, speech and sleep disorders, headaches, hallucinations. Temporary developmental delays are also possible. The condition normalizes within 1-2 months.

Removal of adenoids in children under local anesthesia

Another method of pain relief during adenoid removal in children is local anesthesia. This type of anesthesia is used extremely rarely and only for patients over 7 years old.

Features of local anesthesia:

• To reduce the sensitivity of the surgical field, the mucous membranes are treated with special means. For this purpose, inhalation anesthetics are used in the form of sprays or solutions for instillation into the nasal passages. Intravenous and intramuscular injections are not used.
• The effect of anesthesia depends on the uniformity of the application of the anesthetic drug. With uniform spraying, local anesthesia is not inferior to general. But some tissues can retain their sensitivity even under the action of the anesthetic.
• The disadvantage of local anesthesia is that children watch the operation. Surgical instruments and the sight of blood can cause severe stress. To avoid negative effects, patients are given sedatives.

The main advantage of local anesthesia is that the operation can be performed in an outpatient setting, since no special equipment is required. The patient is sent home immediately after the procedure, since no special monitoring is required after such anesthesia.

Endotracheal anesthesia in children during adenoid removal

Intubation or endotracheal anesthesia in children during adenoid removal is a state of deep drug-induced sleep with complete relaxation of muscles and absence of spontaneous breathing.

Anesthesia consists of several stages:

• Premedication is preparation for immersion into drug-induced sleep. At this stage, cardiac disorders are prevented.
• Tracheal intubation – for artificial ventilation of the lungs, an intubation tube is inserted into the lumen of the trachea.
• Intravenous administration of painkillers: narcotic anesthetics, sedatives, tranquilizers.
• The use of muscle relaxants to block neuromuscular transmission and completely relax the respiratory and striated muscles.
• Supplementing narcotic sleep with inhalation drugs.
• Artificial ventilation of the lungs. Gas exchange is carried out using a special apparatus.
• Awakening is a gradual return of consciousness and restoration of breathing.

Endotracheal anesthesia is multicomponent, therefore it requires adherence to stages during implementation. This type of anesthesia is appropriate for large and complex surgical interventions.

In addition to adenotomy, endotracheal anesthesia is indicated for abdominal surgery, cardiac and thoracic surgery, laparoscopy, brain surgery and other long-term operations. Such a complex method of anesthesia can cause adverse reactions. Most often, complications are associated with medical errors and the severity of the patient's condition.

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