Otolaryngologic clinics of North America
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Otolaryngol. Clin. North Am. · May 1987
ReviewEvaluation of coagulation disorders in patients with diseases of Waldeyer's ring.
The presence of pre-existing hemostatic disorders in a surgical patient may pose difficulties in the care of patients during and after surgery. To reduce the risk of excessive hemorrhage, this article has stressed the value of a thorough medical history, physical examination, and appropriate laboratory assays before surgery. ⋯ However, if the coagulation screening procedure suggests that an abnormality exists, specific diagnostic assays must be performed before any necessary surgery to determine the exact nature of the coagulopathy. When this information is present, specific forms of blood component therapy can be given to minimize the risk of excessive hemorrhage during the operative period.
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The preferred antibiotic treatment for tonsillar and peritonsillar infections remains high dosages of penicillin. Peritonsillar swelling can be probed by needle aspiration. ⋯ Quinsy tonsillectomy may be carried out for the best abscess exposure. Interval tonsillectomy is advised for those patients who give histories of previous tonsillar infections.
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This article deals with fatality rate, causes of death, bleeding, and appropriate measures to prevent or treat such complications. Immunologic disturbances, consequences of tissue trauma, and recurrences after surgery are discussed.
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Despite advances in the anesthetic pharmacopeia and improved noninvasive monitoring techniques, subjective bias and individual clinical experience remain major determinants of individual practice. Medicolegal pressures have increased in recent years, as has the concept of shared responsibility for surgical and anesthetic complications. New standards of anesthesia monitoring and practice are evolving in response to the need for perioperative risk management and cost-effective surgical care. Continued vigilance and close communication between the otolaryngologist and anesthesiologist remain key elements for safe anesthetic practice.
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Tonsillectomy is a safe operative procedure today, but hemorrhage remains a continuing problem. Excessive bleeding requires prompt attention by the surgeon and immediate treatment. Should local measures to control bleeding fail, external carotid artery ligation may be a life-saving procedure.