Introduction

Your doctor has recommended an adenoidectomy for your child. The following information is provided to help you prepare for the surgery, and to help you understand more clearly the associated benefits, risks, and complications. You are encouraged to ask your doctor any questions that you feel necessary to help you better understand this procedure.

The adenoids are a mass of lymphoid tissue located behind the nasal passages. Infected adenoids may become enlarged or chronically infected, and subsequently lead to obstructed breathing, snoring/sleep apnea, sinus or ear infections, or other problems. Adenoidectomy is a surgical procedure performed to remove the adenoids.

These instructions are designed to help your child (and you) recover from the adenoidectomy as easily as possible. Taking care of your child can prevent complications. Your doctor will be happy to answer any questions that you have regarding this material. If your child is having ear tube surgery (myringotomies and tympanostomy tubes placed) in conjunction with his/her adenoidectomy, please visit the following article for further information: Myringotomy.

What are risks and complications of adenoidectomy?

Your child's surgery will be performed safely and with care in order to obtain the best possible results. You have the right to be informed that the surgery may involve risks of unsuccessful results, complications, or injury from both known and unforeseen causes. Because individuals differ in their response to surgery, their anesthetic reactions, and their healing outcomes, ultimately there can be no guarantee made as to the results or potential complications.

The following complications have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. They are listed here for your information only, not to frighten you, but to make you aware and more knowledgeable concerning this surgical procedure.

• Failure to resolve the ear or sinus infections, or relieve nasal drainage.
• Bleeding. In very rare situations, the need for blood products or a blood transfusion. You have the right, should you choose, to have autologous (blood from yourself) or designated donor directed blood prepared in advance in case an emergency transfusion is necessary. You are encouraged to consult with your doctor if you are interested.
• A permanent change in voice or nasal regurgitation (rare).
• Need for further and more aggressive surgery such as sinus, nasal, or tonsil surgery.
• Infection.
• Failure to improve the nasal airway or resolve snoring, sleep apnea, or mouth breathing.
• Need for allergy evaluation, treatments, or environmental controls. Surgery is neither a cure nor a substitute for good allergy control or treatment.

Before Surgery

In most situations, the surgery is performed as an outpatient at either the hospital or the surgicenter. In both facilities, quality care is provided without the expense and inconvenience of an overnight stay. An anesthesiologist will monitor your child throughout the procedure. Usually, the anesthesiologist will call the night before surgery to review the medical history. If he/she is unable to reach you the night before surgery, he/she will talk with you that morning. If your doctor has ordered preoperative laboratory studies, you should arrange to have these done several days in advance.

Your child should not take aspirin, or any product containing aspirin, within 10 days of the date of your surgery. Non-steroidal anti-inflammatory medications (such as ibuprofen/Advil or naproxen/Aleve) should not be taken within 7 days of the date of surgery. Many over-the-counter products contain aspirin or non-steroidal anti-inflammatory type drugs, so it is important to check all medications carefully. If there is any question, please call your doctor's office or consult your pharmacist. Acetaminophen/Tylenol is an acceptable pain reliever. Often, your doctor will give you several prescriptions for post-operative pain at the visit BEFORE the operation. It is best to have these filled prior to the date of your surgery.

It is advised that you be honest and up front with your child as you explain his/her upcoming surgery. Encourage your child to think of this as something the doctor will do to made them healthier. Let them know that they will be safe and that you will be close by. A calming and reassuring attitude will greatly ease your child's anxiety. You can assure them that most children have minimal pain following an adenoidectomy. Let them know that if they do have pain, it will only be for a short time, and that they can take medicines which will greatly reduce it.

Your child must not eat or drink anything 6 hours prior to their surgery time. This even includes water, candy, or chewing gum. Anything in the stomach increases the chances of an anesthetic complication.

If your child is sick or has a fever the day before surgery, call the doctor's office. If your child wakes up sick the day of surgery, still proceed to the surgical facility as planned. Your doctor will decide if it is safe to proceed with surgery. However, if your child has chickenpox, do not bring your child to the office or to the surgical facility.

The Day of Surgery

It is important that you know precisely what time you are to check in with the surgical facility, and that you allow sufficient preparation time. Bring all papers and forms with you, including the preoperative orders and history sheets. Your child is to wear comfortable loose fitting clothes (pajamas are OK). Leave all jewelry and valuables at home. He/she may bring a favorite toy, stuffed animal, or blanket.

During Surgery

In the operating room, the anesthesiologist will usually use a mixture of gas and an intravenous medication for the general anesthetic. In most situations, an IV will have been started either in the preoperative holding room or after the child has been given a mask anesthetic. During the procedure, your child will be continuously monitored by pulse oximeter (oxygen saturation) and heart rhythm (EKG). The surgical team is well trained and prepared for any emergency. In addition to the surgeon and the anesthesiologist, there will be a nurse and a surgical technician in the room.

After the anesthetic takes effect, the doctor will remove the adenoids through the mouth. There will be no external incisions. The base of the adenoids will be cauterized with an electrical cauterizing unit. The whole procedure usually takes less than 45 minutes. Your doctor will come to the waiting room to talk with you once your child is safely in the recovery room.

After Surgery

After surgery, your child will be taken to the recovery room where a nurse will monitor him/her. You will probably be invited into the recovery room as your child becomes aware of their surroundings and starts looking for you. Your child will be able to go home the same day as the surgery once he/she has fully recovered from the anesthetic. This usually takes several hours.

It is best for your child to eat a light, soft, and cool diet as tolerated once they have recovered fully from the anesthetic. Avoid hot liquids for several days. Even though they may be hungry immediately after surgery, it is best to feed them slowly to prevent postoperative nausea and vomiting. Occasionally, a child may vomit one or two times immediately after surgery. However, if vomiting persists, your doctor may prescribe medication to settle the stomach. It is important to remember that a good overall diet with ample rest promotes healing.

They will be prescribed antibiotics after surgery, and should finish all the pills that have been ordered. Some form of a narcotic will also be prescribed (typically, acetaminophen/Tylenol with codeine), and is to be taken as needed. If you have any questions or you feel that your child is developing a reaction to any of these medications, you should consult your doctor. You should not give any other medications, either prescribed or over-the-counter, unless you have discussed it with your doctor.

General Instructions and Follow-Up Care

An appointment for a checkup should be made 10 to 14 days after the procedure. Call the office to schedule this appointment.

It is not unusual for children to have nasal stuffiness following surgery. The nasal stuffiness may last for several months as swelling decreases. Saline nose drops (Ocean Spray) can be used to help dissolve any clots and decrease edema. You may notice persistent or even louder snoring for several weeks. A temporary change in voice is common following surgery, and will usually return to normal after several months. Your child, of course, will sound less "nasal" following surgery.

Bleeding is rare following an adenoidectomy. They may have some very light nasal bleeding, if it is minor, pediatric Neosynephrin nose drops can be used. If it is persistent and bright red in color, call your doctor. On occasion, blood at the corner of the eye may be noticed.

Most patients require at least 7-10 days off from work or school. After 3 weeks, exercise and swimming can usually be resumed, but no diving for two months. You should plan to stay in town for 3 weeks to allow for postoperative care and in case you have bleeding.

Notify Your Doctor If Your Child Has:

• A sudden increase in the amount of bleeding from the nose unrelieved by pressure, ice, and head elevation.
• A fever greater than 101.5 degrees F which is persistent despite increasing the amount of fluid they drink, cool baths, and acetaminophen/Tylenol. A child with a fever should try to drink approximately one-half cup of fluid each waking hour.
• Persistent sharp pain or headache which is not relieved by the pain medication they were prescribed.
• Increased swelling or redness of the nose or eyes.

Adenoidectomy Surgical Instructions At A Glance

• Adenoidectomy is a surgical procedure performed to remove the adenoids.
• Adenoids are a mass of lymphoid tissue located behind the nasal passages.
• All surgical procedures have risks and potential complications.
• Understanding what is involved before, during, and after adenoidectomy can help your child (and you) recover from the surgery as easily as possible.

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