A devastating outcome after adenoidectomy and tonsillectomy: Ideas for improved prevention and management

To develop strategies that may assist the surgeon to prevent and manage severe bleeding complications after adenoidectomy and tonsillectomy. Retrospective. Expert reports for malpractice lawsuits or professional boards were reviewed. The review was restricted to “deaths” and “permanent generalized n...

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Veröffentlicht in:Otolaryngology-head and neck surgery 2009-02, Vol.140 (2), p.191-196
Hauptverfasser: Windfuhr, Jochen P., Schloendorff, Georg, Sesterhenn, Andreas M., Prescher, Andreas, Kremer, Bernd
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container_end_page 196
container_issue 2
container_start_page 191
container_title Otolaryngology-head and neck surgery
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creator Windfuhr, Jochen P.
Schloendorff, Georg
Sesterhenn, Andreas M.
Prescher, Andreas
Kremer, Bernd
description To develop strategies that may assist the surgeon to prevent and manage severe bleeding complications after adenoidectomy and tonsillectomy. Retrospective. Expert reports for malpractice lawsuits or professional boards were reviewed. The review was restricted to “deaths” and “permanent generalized neurological deficiencies.” Forty-three cases matched our search criteria, including 32 deaths. Adenoidectomy cases (2) were associated with immediate bleeding because of direct vascular injury resulting in one death. Tonsillectomy cases were associated with delayed and repeated episodes of bleeding resulting in 31 deaths, including 19 children. Autopsy verified predominantly aspiration and vascular injuries. An apallic syndrome prevailed in surviving patients. Careful inspection of the nasopharynx immediately before adenoidectomy and curettage in a piecemeal fashion under visual control is helpful to prevent direct injury to aberrant arteries. Tonsillectomy cases are associated with delayed and episodic bleeding with spontaneous cessation and young age. Inpatient observation should be strongly considered in cases with repeated bleeding episodes to provide immediate treatment. The follow-up should be focused on disturbed wound healing. Outcome appears to be dependant on adequate airway management. Rigid instruments and tracheotomy in case of intubation failure are highly recommended to facilitate airway protection and ventilation.
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subjects Adenoidectomy - adverse effects
Adenoidectomy - mortality
Adolescent
Adult
Aged
Child
Child, Preschool
Cohort Studies
Female
Humans
Male
Middle Aged
Nervous System Diseases - etiology
Nervous System Diseases - mortality
Nervous System Diseases - prevention & control
Postoperative Hemorrhage - etiology
Postoperative Hemorrhage - mortality
Postoperative Hemorrhage - prevention & control
Retrospective Studies
Risk Factors
Tonsillectomy - adverse effects
Tonsillectomy - mortality
Treatment Outcome
Young Adult
title A devastating outcome after adenoidectomy and tonsillectomy: Ideas for improved prevention and management
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