![]() ![]() More often, the extent of blood loss will be difficult to accurately assess. 18 Presentation may be dramatic with frank blood in the patient’s mouth or bloody emesis. Therefore, resuscitation is the primary therapeutic goal before surgical intervention. ![]() Post-tonsillectomy bleeds are rarely emergent arterial bleeds. Regardless of the actual nil per os time, patients with a bleeding tonsillar fossa are assumed to have a stomach full of swallowed blood. This finding was also not significantly different in the 42.2% of children having 2 episodes of post-tonsillectomy bleeding.Ībbreviation: RSII, rapid sequence induction and intubation. In children with a single post-tonsillectomy bleeding episode, no coagulopathies were identified despite 34.8% of them having an abnormal PT or activated partial thromboplastin time (aPTT). Two out of the three children diagnosed with a coagulopathy had normal labs, while the remaining one patient had a slightly elevated prothrombin time (PT). In the 250 children presenting with PTH, only three were diagnosed with an occult coagulopathy (13%). 9 The authors found that even in children presenting with multiple episodes of post tonsillectomy bleeding, a diagnosis of coagulopathy was rarely uncovered. In 2020, a case series that included a chart review of 250 children with PTH attempted to define the rate and identify characteristics of post tonsillectomy bleeding that would lead to a diagnosis of occult coagulopathy. A meta-analysis including data from over 3000 patients found no difference in the rate of PTH when comparing patients with normal or abnormal preoperative coagulation studies, 8 and routine preoperative coagulation studies are no longer recommended if there is no personal or family history concerning for coagulopathy or if family history is not available ( ). 7 Historically, surgeons have attempted to identify undiagnosed coagulopathy by obtaining preoperative coagulation studies in children scheduled for tonsillectomy. In terms of patient factors, obesity has not been shown to be associated with increased PTH in adults or children. 5 Partial (intracapsular) tonsillectomy may decrease the risk of post tonsillectomy bleeding when compared with total (extracapsular) tonsillectomy. ![]() However, the level of evidence and quality of evidence supporting this is low. The risk of secondary bleeding may be slightly higher with coblation. 4 However, a Cochrane database review published in 2017 was unable to demonstrate a difference in the rate of primary post-tonsillectomy hemorrhage when comparing coblation with other techniques. A recent study found that the risk factors associated with an increased risk of post-tonsillectomy bleeding included coblation and surgeon inexperience for primary bleeding, and age over 6 years for secondary bleeding. ![]()
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