Adenotonsillectomy

Setting

  • WIPER  (wash hands, introduce yourself, permission, expose patient, reposition) 
  • Ask if the patient is happy to see you

Perception

  • Check what the patient understands so far
  • What symptoms are they having and what treatments they have tried so far

Invitation 

  • Ask if they would like to know more about the operation
  • Ask permission to take consent
  • Explain you will outline the procedure, alternatives, risks and benefits, recovery time.
  • ‘If at any point you have any questions feel free to interrupt me, but I’ll also ask you afterwards if you have any questions’

Knowledge

  • Explain procedure
  • Draw diagram if necessary
    • Explain alternatives
    • Intended benefits
    • Potential risks and complications
      • With any operation, risk of bleeding, infection, pain, risk of GA – anaesthetist will be able to go through in more detail. See General Risks below
      • Also specific risks associated with this operation. 
  • Secondary haemorrhage (up to 10 days post-op)
    • Return to theatre
  • Nasal regurgitation (Temporary/Permanent)
  • Altered taste 
  • Uvula asymmetry
  • Palatal asymmetry
  • Foreign body sensation in throat
  • Singing voice change
    • May still get sore throats (pharyngitis not tonsillitis)
    • Individual risks to patient 

Post op

  • Most likely to be day case procedure rarely may need overnight stay (depending on local policy)
  • Time off work or school – give sick note
  • Contact department/attend A&E if: any bleeding up to 10 days post-op, fever, pain not responding to analgesics

Follow up advice

  • See back in clinic in X weeks/months

Summary

  • Summarise consultation
  • Offer opportunity to ask questions
  • Offer patient information leaflet
  • Thank patient, wash hands and close

General Risks

  • Bleeding and bruising
  • Infection
  • Pain
  • Scar
  • Risk of general anaesthesia
  • Further surgery
  • Return to theatre
  • Recurrence
  • Suboptimal outcome
  • Numbness
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