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E V O L U T I O N
majority of my patients undergo traditional tonsillectomy. That they
recover nicely is telling, and offers promise for the potential of performing these procedures in same-day settings.
Up until about 2 years ago, I'd use Tylenol with codeine to control
post-op pain. The problem with the Tylenol-codeine combo, other
than the FDA-issued black-box warning for its use in pediatric tonsillectomy and adenoidectomy patients, is that some patients hypermetabolize codeine, turning most of the drug into morphine.
Hypermetabolizers who struggle with obstructive sleep apnea — as
many of these patients do — have a higher degree of respiratory suppression. Because of all these factors, we now use oxycodone in the
recovery room to make patients comfortable.
We've standardized our anesthesia technique, which includes the
routine use of dexamethasone to decrease post-op airway edema as
well as newer classes of antibiotics and antiemetics to reduce post-op
complication risks.
We employ a step-down recovery unit with well-trained nurses.
Patients often spend a couple hours in the regular recovery room then
move to the step-down unit for another couple hours until they're
ready for discharge. Overall, patients remain under our care for about
5 hours post-op.
Where we stand
I used to admit all of my patients, but parents started to wonder why
their kids had to stay in the hospital when they were seemingly fully
recovered from surgery. It was hard to argue. I began to check on
admitted patients around 9 p.m., after they'd been in the hospital for 8
hours. Most were doing great. After a couple years of monitoring
patients' recoveries, I decided to see if we could start sending some of
them home on the day of surgery. My research showed we could.
