Ear Center: Preoperative Surgery Instructions for Adenoidectomy

PREPARING YOUR TODDLER FOR SURGERY - ADENOIDECTOMY

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Age 12 months to 3 years
Age 3 - 6 years
Adenoidectomy
What happens the day of surgery?
References

AGE 12 MONTHS TO 3 YEARS

  1. Please do not give your child ibuprofen (children's Motrin® or NSAIDS) or any aspirin or aspirin-containing medications for 10 DAYS prior to adenoidectomy.  Such products can promote bleeding by inhibiting platelet function.
  2. It is fine to administer Tylenol® (acetaminophen) or Tylenol® containing medications.
  3. We suggest that you do not try to prepare your toddler for surgery until the day before or the morning of the procedure. Toddlers have not yet developed a good sense of time and talking about the operation too far ahead of time will not have very much meaning.
  4. It may help to use a doll to serve as a "patient" and demonstrate to your child what will happen to him. Allow your child to play with a toy doctor's kit and masks or gowns. Allow your child to touch and manipulate some of the things that will be used during the operation such as an anesthesia mask or blood pressure cuff.
  5. Describe the special set of pajamas (hospital gown) that your child will put on at the surgery facility. Explain that he may wear his own underwear as long as it is cotton.
  6. Let your child take a favorite toy, blanket, or pacifier to the operating room with him for security.
  7. Describe the anesthesia as a "special nap" that is different from his usual sleep at home. Avoid using the term "being put to sleep" as your child may confuse this with animals that have been put to sleep by your veterinarian. Children know that a "nap" is brief and that they will see their parents after a nap.
  8. Reassure your child that you will see him immediately after the surgery and that the nurses and doctors are there to help him.
  9. Be realistic with your child and avoid fairytales. Young children are very preoccupied with blame and guilt. It is important to reassure your child that he is not being punished for anything he has done.
  10. After the operation, allow your child to continue to play with the "operated" doll to help him deal with what has happened to him.
  11. Your child may regress somewhat after the operation. There may be some disruption in potty training or recently acquired skills. He may be clingy or fearful for a day or two, and there may be some night waking. These are normal behaviors and will generally disappear within a few days. Be supportive, comforting, and gently urge your child to resume his normal activities and routines.

AGE 3 YEARS TO 6 YEARS

We suggest that you begin to prepare your preschooler for his operation about 2-3 days before the procedure.

  1. Please do not give your child ibuprofen (children's Motrin® or NSAIDS) or any aspirin or aspirin-containing medications for 10 DAYS prior to adenoidectomy.  Such products can promote bleeding by inhibiting platelet function.
  2. It is fine to administer Tylenol® (acetaminophen) or Tylenol® containing medications.
  3. It may help to use a doll to serve as a "patient" and demonstrate to your child what will happen to him. Allow him to play with a toy doctor's kit and masks or gowns. Allow him to touch and manipulate some of the things that will be used by the anesthesia team during the operation such as an anesthesia mask and blood pressure cuff.
  4. Describe the special set of pajamas (hospital gown) that your child will put on at the surgical facility. Explain that he may wear his own underwear as long as it is cotton.
  5. Encourage your child to ask questions and praise him for doing so.
  6. Let your child take a favorite toy or blanket to the operating room with him for security.
  7. Describe the anesthesia as a "special nap" that is different from his usual sleep at home. Avoid using the term "being put to sleep" as your child may confuse this with animals that have been put to sleep by your veterinarian. Children know that a "nap" is brief and that they will see their parents after a "nap".
  8. Remember that preschoolers are highly imaginative and may fantasize about what might be wrong with their throat and why. Reassure your child that he did nothing to cause his illness and that the operation is not punishment of any kind.
  9. Prepare your child for some discomfort after the operation and focus on things that they can do to help themselves feel better such as taking Tylenol® and drinking plenty of liquids.
  10. A tour of the surgical facility a day or two before the procedure may help to decrease your child's anxiety and prompt questions. Contact the surgical facility to arrange for a visit. The phone number for the SCA Surgical Center is (336) 272-0012. The number for the Cone Day Surgery Center is (336) 832-7100.
  11. After the surgery, allow your child to continue to play with the "operated" doll so that he can play-act some of his experiences.
  12. Your child may regress somewhat after the surgery. There may be some disruption of recently acquired skills. He may be clingy and fearful for a few days, and there may be some night waking. These normal behaviors will generally disappear in a few days. Be supportive, comforting, and gently urge him to resume his usual routines.

ADENOIDECTOMY - PURPOSE

The adenoids are normal body lymphoid tissue made of B cells. B cells make antibodies or immunoglobulins for our body. Their normal purpose is to help to protect our ears, nose, and throat against diseases. However, sometimes the adenoids become diseased themselves (due to biofilms) and cause us to become sick. A recognized relationship exists between adenoid disease and recurring ear infections. In addition, the adenoid may become enlarged and obstruct breathing, especially at night. If these things happen, it often helps to remove the adenoids. The operation to remove the adenoids is called an "adenoidectomy". Adenoidectomy may be done alone but is commonly performed along with insertion of ear tubes. In most patients, adenoid tissue naturally disappears by the age of 20 years.

LOCATION
The adenoids are located in the highest part of the throat (nasopharynx), above and behind the roof of the mouth.

PROCEDURE
An adenoidectomy is a short operation and is usually performed on an outpatient basis in an ambulatory surgical center. Adenoidectomy usually does not require an overnight hospital stay. The operation is performed through the mouth, and there is usually very little bleeding. No stitches are required.

WHAT HAPPENS THE DAY OF SURGERY? - ADENOIDECTOMY

  1. The patient should arrive at the surgical facility and check in 1-2 hours before the operation is scheduled to begin. You will be given an arrival time by our nursing staff.
  2. The patient will have their temperature taken. The anesthesiologist will talk to the patient (and parents) and then listen to the patient's heart and lungs.
  3. When the operation is about to begin, a nurse anesthetist will take the patient to the operating room. Your child may take a favorite toy or security object along with him.
  4. In the operating room, the patient will "take a nap" by breathing Nitrous Oxide and Sevoflurane through a mask placed over the patient's face. Once asleep, an IV is placed in his hand, and a breathing tube (endotracheal tube) is put into his windpipe to continue the anesthesia. Your child's heart rate, blood pressure, temperature, and blood oxygen levels will be monitored continuously throughout the procedure.
  5. An adenoidectomy operation takes about 30 minutes. After the operation, the patient will go to the recovery room to "wake up" from the anesthesia. Shortly after that, you will be reunited with your child.
  6. The IV will be left in the patient's hand until they are ready to go to the recovery room.
  7. Some patients may feel nauseated after the operation and may vomit. Offer clear liquids initially. If there is no nausea, small light meals are best tolerated the day of surgery. A normal diet may be resumed once nausea has passed. Your doctor may give you additional instructions as needed.
  8. General anesthesia may cause some irritability or fussiness for a few hours. Some children will take a longer afternoon nap than usual. Most children will have fully recovered from the anesthesia by the late afternoon.
  9. Some children may snore for a few evenings after having an adenoidectomy. Occasionally, a "nasal odor" will be present for up to one week until the healing process has been completed.
  10. If you have any questions, please contact our nursing staff at (336) 273-9932.

 

References

  1. Kadhim AL, Spilsbury K, Semmens JB, Coates HL, Lannigan FJ. Adenoidectomy for middle ear effusion: a study of 50,000 children over 24 years. Laryngoscope 2007;117(3):427-433.
  2. Lee MR, Pawlowski KS, Luong A, Furze AD, Roland PS. Biofilm presence in humans with chronic suppurative otitis media. Otolaryngol Head Neck Surg, 2009, 141(5), 567-571.
  3. Winther B, Gross BC, Hendley JO, Early SV. Location of Bacterial biofilm in the mucus overlying the adenoid by light microscopy. Arch Otolaryngol Head Neck Surg, 2009, 135(12), 1239-1245.

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Last revised November 28, 2011