Patient's question:
A 9-month-old baby 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 worsened slightly, and there has also been coughing at night. There is a sensation of phlegm as well. After taking the two medications mentioned above, they were given Cefixime at night. About half an hour 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, in order 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 any 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: Bleeding within 24 hours after surgery is primary bleeding, which is more common and often occurs within 6 hours postoperatively. 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 that are aggravated 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 usually occurs 5–6 days after surgery, primarily when the white membrane begins to shed and hard food causes abrasion, leading to bleeding. This can be prevented with proper attention. If the bleeding is secondary and infectious, stronger measures such as antibiotics should be taken.
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 in the upper and lower parts of the tonsillar fossa, the region near the base of the tongue, and the posterior part of the palatoglossal arch, as these are harder to see. If there are obvious bleeding points, they should be clamped with forceps and ligated.
2. Diffuse oozing can be managed by applying hemostatic powder or gelatin sponge to the bleeding site for compression. If 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 be suddenly vomited out as large amounts of bloody material. The patient may exhibit early shock symptoms such as rapid pulse, pale complexion, and cold sweat. Immediate measures such as fluid replacement, blood transfusion, and hemostasis should be taken 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 should never be used on adhered tissues. If this occurs, immediate compression should be applied, 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 formation on the wound, dirty or incomplete white membrane, severe pharyngeal congestion, swelling, and pain, sometimes accompanied by fever. Sufficient antibiotics and 0.5–1% hydrogen peroxide rinsing should be used.
(3) Other Complications: Pneumatocele, bronchopneumonia, atelectasis, deep cervical abscess or cellulitis, and respiratory tract foreign bodies may also occur.
Prevention:
First and foremost, it is important to enhance the body's resistance and maintain a balance between work and rest. Many people often work overtime, which can easily lead to tonsillitis. Second, smoking and alcohol consumption should be reduced, and good study and living habits should be developed. Additionally, nearby organ diseases, such as acute or chronic rhinitis, should be actively treated.