A 8 year boy operated for tonsillectomy developed secondary hemorrhage in postoperative period. ENT surgeon wants to re explore to tic the bleeders. All of the following measures should be taken during anaesthesia, except:
|A||Before induction patient should be nursed in latera position|
|B||IPPV with bag and mask|
|C||Injection metoclopramide and injection ranitidine before induction|
|D||Intubation with cuffed tubes only|
|E||Hemodynamic stability before considering for anaesthesia|
IPPV with bag and mask
a. Secondary bleeding from tonsillar fossa is a common problem after tonsillectomy. At times patient may develop hypotension.
b. Immediate correction of hypotension should be done with colloids and once the patient is stabilized reexploration under GA should be undertaken.
c. These patients should be considered as full stomach (due to blood in stomach) and all precautions for full stomach patient like metoclopramide ranitidine, crash intubation with Sellik's manoeuvre, avoiding bag and mask ventilation must be taken.
d. As these patients are at high risk of aspiration they should be nursed in lateral position (tonsillar position) and only cuffed endotracheal tubes should be used (or if uncuffed tube is used throat should be packed).