Removal of adenoids in children: which anesthesia is better?

For the first time, surgical treatment of inflamed tonsils was carried out at the end of the 19th century. At that time anesthesia was not applied, so the patient fully felt and observed all the features of such therapy. To date, the operation is under general anesthesia: local or general.

In most cases, the removal of adenoids in children under general anesthesia. Despite the fact that this kind of anesthesia is associated with certain risks and side reactions, modern medical methods allow eliminating such risks in 99% of cases.

Advantages of adenotomy under anesthesia:

• Absolute painlessness.
• Exclusion of traumatization of the psyche of a small patient and lack of resistance on his part.
• Minimal risk of inhalation of removed tissue.
• Qualitative completion of the procedure: comprehensive examination and tamponing.

Consider the main types of anesthesia:

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

During the procedure, the patient does not experience pain, but may be afraid of medical manipulation or the type of blood. Therefore, local anesthesia is combined with intramuscular administration of sedative medications. The peculiarity of such anesthesia in its low cost, the absence of complications and adverse reactions. Local anesthesia is only used when parents are confident in the endurance and persistent nature of their child.

2. General anesthesia is the most popular form of anesthesia. Helps the psyche of the young patient and creates favorable conditions for the operation. Since the baby is unconscious, the doctor can completely remove the adenoid tissue. This type of anesthesia has certain risks and complications.

The decision on the method of anesthesia is taken by an anesthesiologist after studying the main indicators of health and the severity of the inflammation. Particular attention is paid to the risk of developing allergic reactions to used anesthetics. Removal of adenoids in children under 7 years of age is carried out only under general anesthesia, for the elderly, local anesthesia is possible. As for the side effects of anesthesia, they are temporary and develop in 1% of patients. Most often, patients face such symptoms: drowsiness, nausea and vomiting, nosebleeds.

Removal of adenoids in children under general anesthesia

In most cases, the removal of adenoids in children under general anesthesia. This is due to the fact that local anesthesia is very difficult to conduct qualitatively, 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. The exit from anesthesia is prolonged and accompanied by unpleasant sensations. Perhaps the development of adverse reactions.

Advantages of general anesthesia:

• Absence of painful sensations during the procedure.
• Reducing the risk of psychological problems after surgery.
• Low risk of postoperative complications.
• The removal lasts no more than 30 minutes.

With regard to the deficiencies, they can be attributed 1% risk of complications, which manifest themselves as nasal bleeding. The risk of developing infection, dental damage or aspiration is minimized. In some cases, there are problems with maintaining a stable body temperature, that is, hyperthermia.

Immediately after getting out of anesthesia, the child may have hearing, speech and sleep disorders, headaches, hallucinations. Also, a temporary lag in development is possible. The condition is normalized within 1-2 months.

Removal of adenoids in children under local anesthesia

Another way of anesthetizing when removing adenoids in children is local anesthesia. Such anesthesia is used extremely rarely and only for patients older than 7 years.

Features of local anesthesia:

• To reduce the sensitivity of the operating field, the mucous membranes are treated with special means. To do this, use inhalation anesthetics 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. With uniform spraying, local anesthesia is not inferior to the general one. But some tissues, even with the action of anesthetic, can maintain their sensitivity.
• The drawback of local anesthesia is that children observe the course of the operation. The surgical instruments and the type of blood can cause severe stress. In order to avoid negative phenomena, patients are given sedatives.

The main plus of local anesthesia is that the operation can be performed in an outpatient setting, as special equipment is not required. Immediately after the procedure, the patient is released home, because after such anesthesia, special monitoring is not required.

Endotracheal anesthesia in children with removal of adenoids

Intubation or endotracheal anesthesia in children with the removal of adenoids is a state of deep medication sleep with complete relaxation of the muscles and lack of independent breathing.

Anesthesia consists of several stages:

• Premedication is the preparation for immersion in medication sleep. At this stage, prevention of cardiac disorders is carried out.
• Intubation of the trachea - for artificial ventilation of the lungs in the lumen of the trachea, an intubation tube is inserted.
• Intravenous injection of painkillers: narcotic anesthetics, sedatives, tranquilizers.
• The use of muscle relaxants to block neuromuscular transmission and complete relaxation of the respiratory and striated muscles.
• Addition of narcotic sleep by inhalation preparations.
• Artificial ventilation of lungs. Gas exchange is carried out with the help of a special apparatus.
• Awakening is the gradual return of consciousness and the restoration of breathing.

Endotracheal anesthesia is multicomponent, so it requires compliance with the stages in the conduct. This type of anesthesia is suitable for large and complex surgical interventions.

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

[1], [2], [3], [4], [5], [6], [7]