Removal of tonsils (tonsillectomy)
Last reviewed: 18.10.2021
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The modern attitude towards the removal of tonsils is based on developed in the late XIX and in the first half of the XX century. Provisions on indications and contraindications to this operation, which are based on scientifically substantiated achievements of medical science in the field of hematology, the doctrine of the toxic and allergic states of the body, focal infection and its role in the occurrence of diseases of internal organs, etc. In determining indications for tonsillectomy (removal of the tonsils), the physician must have a "dialectic of diagnosis", ie, use the principle of the old Russian doctors - "meditate at the patient's bed", which means an analytical approach to chronic tonsicles (as well as to any other disease) and forthcoming treatment as a systemic process, which includes factors such as the general condition of the patient, the state of his individual organs and systems, especially those with close anatomophysiological connections to the object of surgical intervention, the choice of the optimal method of treatment, possible consequences of surgical intervention, etc. Often such a correct approach to the development of tactics and treatment strategies for chronic tonsillitis is replaced by the principle (or rather an unscrupulous approach m) "no tonsils - no problem," and the patient "sentence" is not indifferent to the for his body to an optional in many cases, the removal of the tonsils.
Tonsillectomy (tonsillectomy) under general anesthesia. Recently, tonsillectomy (removal of tonsils) is becoming more common under general intubation anesthesia, the indications to which are determined by an ENT surgeon, and contraindications are estimated by an anesthesiologist. Most often, it is produced in childhood, when children are panic-stricken about surgery, or when they have certain diseases of the nervous system manifested by hyperkinesia, seizures of epilepsy, etc. These same indications are also applicable to adult patients, especially with indomitable gag reflex. Preparation for general anesthesia is carried out under the supervision of an anesthesiologist, and during this period, the vital functions of the body are corrected, the activity of the blood coagulation system is increased, and the body is saturated with the necessary vitamins. After the introduction of the patient into the narcotic state, all stages of the operation are similar to those that are performed under local anesthesia. The position of the patient is on the back with the head as large as possible thrown back (hanging). The surgeon in the sitting position is behind the patient at his head, therefore the endoscopic picture of the throat is presented in an "upside down" form. It is also possible to operate with the traditional position of a doctor. Advantages of tonsillectomy (removal of tonsils), conducted under intubation anesthesia, is the complete absence of a pharyngeal reflex, the possibility of calm and careful manipulation in the operating field and the conduct of thorough hemostasis. Absence of vomitive attempts sharply reduces the bleeding of blood vessels, and the ability to control blood pressure makes this operation safe even in patients with hypertensive disease or suffering from renal or adrenal hypertensive syndrome.
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