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June 05, 2018

Tonsillectomy WITHOUT General Anesthesia Using Only Local Anesthesia

I always thought that tonsillectomy can only be performed under general anesthesia. I was wrong... In some countries even now, awake tonsillectomy is routinely performed using only local anesthesia. There has even been some papers written on this topic which I was not aware of until now.

According to one 2018 paper, a local anesthetic tonsillectomy without general anesthesia is performed the following way:
...cold steel method of dissection, using tonsillar snare at the inferior tonsillar poles... Hemostasis was performed through bipolar electro-cauterization and suture ligations in a minority of cases.

Local anesthesia consisted of 15 mL of 1% lidocaine with 1:200,000 adrenaline, infiltrated into the upper and lower pole of both tonsils and four sprays (7.5 mg per dose) of 15% lidocaine spray immediately prior to surgery. The patient in the local anesthesia group were premeditated with 0.6mg of atropine and diazepam half an hour prior to surgery... bleeding incidents... were managed through compression with or without local adrenaline application.
Not sure if this local anesthesia tonsillectomy option will ever be offered in the United States. Personally, I would be too scared to try!

Click to watch a tonsillectomy video here!


References:
Risks and benefits of local anesthesia versus general anesthesia in tonsillectomy. Am J Otolaryngol. 2018 May 26. pii: S0196-0709(18)30376-4. doi: 10.1016/j.amjoto.2018.05.015. [Epub ahead of print]

Tonsillectomy under local anesthesia: a safe and effective alternative. Am J Otolaryngol. 1990 Jan-Feb;11(1):18-22.

Tonsillectomy: a clinical study comparing the effects of local versus general anesthesia. Laryngoscope. 1986 Mar;96(3):308-10.

[Risk of postoperative hemorrhage in tonsillectomy. A comparison between general anesthesia and local anesthesia]. HNO. 2002 Mar;50(3):230-2.

Tonsillectomy under local anesthesia: a safe and effective alternative. Am J Otolaryngol. 1990 Jan-Feb;11(1):18-22.

Retrospective comparison of local versus general anaesthesia for tonsillectomy. Laryngoscope. 1987 May;97(5):643-4.

Advantages of Tonsillectomy done under Local Anesthesia Compared to General Anesthesia in Adults. Int J Head Neck Surg. 2013;4(1):13-8.

A comparison of postoperative bleeding incidence between general and local anesthesia tonsillectomies. Otolaryngol Head Neck Surg 1990;6: 654–657.

Risk of postoperative hemorrhage in tonsillectomy. A comparison between general anesthesia and local anesthesia. HNO. 2002;50(3):230-2.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. He is also the chief medical officer of O2Labz, a medical and scientific 3D animation company.Google+ Christopher Chang, MD Bio

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