Patient's question:
A 9-month-old infant has a slight runny nose, mild cough, and is reluctant to eat; they have been taking Bao Ying Wan and Xiao Er Ke Cough Granules. Over the past 3 days, the runny nose and cough have become slightly worse, and there has also been coughing at night, along with a sensation of phlegm. This is due to taking the two aforementioned medications. In the evening, they took Cefixime, and about 30 minutes later, they started to feel a bit feverish.Doctor's answer:
(1) All patients are positioned in the lateral decubitus position. For local anesthesia, patients are instructed to allow secretions in the mouth to flow out along the corners of the mouth and not to swallow them to observe for any bleeding. For general anesthesia, attention should be paid to the patient's swallowing movements before they regain consciousness. If swallowing is observed, check for bleeding.(2) Fluid diet can be introduced three hours after surgery, and saltwater rinsing can be used six hours later. Cold compresses can be applied to the neck when there is wound pain.
(3) On the second day after surgery, a white membrane may appear on the wound, which is a normal reaction. The membrane typically begins to shed 5–7 days after surgery, and granulation tissue forms on the wound, with epithelial growth starting on the surface. If the membrane appears grayish, infection should be suspected, and antibiotics along with a 0.5–1% hydrogen peroxide solution rinse should be used.
Surgical Complications and Their Management
(1) Bleeding:
- Primary bleeding occurs within 24 hours after surgery and is more common, usually happening within the first 6 hours. It may be due to inadequate surgical precision, residual tissue, incomplete hemostasis, or the loss of vasoconstrictive effects of epinephrine in anesthetics. It could also be caused by minor bleeding points exacerbated by throat movement, coughing, or temporary blood pressure increases. Lack of vitamin C, reduced prothrombin levels, or sudden changes in weather can also promote postoperative bleeding.
- Secondary bleeding typically occurs 5–6 days after surgery, often when the white membrane begins to shed and hard food causes abrasion. This can usually be prevented with attention. If secondary bleeding is due to infection, stronger treatment, such as antibiotics, may be required.
1. If blood clots are present in the tonsillar fossa, they should be removed, and a gauze ball should be applied for 10–15 minutes of pressure. When examining bleeding points, pay attention to hidden areas above and below the tonsillar fossa, as well as near the base of the tongue and behind the palatoglossal arch, where bleeding points may be difficult to see. If obvious bleeding points are found, they should be clamped and ligated with forceps.
2. For diffuse bleeding, a hemostatic powder or gelatin sponge can be applied to the bleeding site. If this is ineffective, a sterile gauze ball can be packed into the tonsillar fossa, and the palatoglossal and palatopharyngeal arches should be sutured with 3–4 stitches, with gauze left in the tonsillar fossa for 24 hours.
3. Sometimes, patients swallow blood, which accumulates in the stomach without being noticed. When a sufficient amount is present, it may suddenly be vomited as bloody material. The patient may exhibit early shock symptoms, such as rapid pulse, pale complexion, and cold sweat. In such cases, measures like fluid replacement, blood transfusion, and hemostasis should be taken immediately to rescue the patient.
4. Injury to the internal carotid artery is rare but can lead to severe bleeding and death if not treated promptly. During surgery, the tonsil should be dissected closely to the tonsillar capsule, with separation not going too deep. Sharp instruments like knives or scissors should never be used on adhered tissues. If this occurs, immediate pressure should be applied to stop bleeding, followed by an end-to-end anastomosis of the internal carotid artery via the external carotid artery.
(2) Wound Infection:
Wound infection may occur if the patient's resistance is low, sterile techniques are not strictly followed during surgery, or bleeding occurs postoperatively. Symptoms include the absence of white membrane growth on the wound, dirty or incomplete white membrane, severe pharyngeal congestion, swelling, and pain, sometimes accompanied by fever. Sufficient antibiotics and a 0.5–1% hydrogen peroxide rinse should be used.
(3) Other Complications:
Other complications may include lung abscess, bronchopneumonia, atelectasis, deep cervical abscess or cellulitis, and respiratory tract foreign bodies.
Prevention:
First and foremost, it is essential to strengthen the body's resistance and maintain a balance between work and rest. Many people often work overtime, which can easily lead to tonsillitis. Additionally, reducing irritants like smoking and alcohol and developing good study and living habits is important. It is also necessary to actively treat adjacent organ diseases, such as acute or chronic rhinitis.