order to obtain a specimen of tissue or secretions for pathological examination or to
instill a drug. Both psychological and drug preparation are needed in order to have the
patient relaxed. An oral sedative is given the night before and again about an hour
before the examination.
b. Setup. Check the surgeon's card for the exact equipment required. It will
also be necessary to find out the type of anesthetic needed. Very small infants will
probably not need an anesthetic; children and adults who cannot relax are given a
general anesthetic; adults who are well prepared do very well with the application of a
topical anesthetic of lidocaine (Xylocaine ), tetracaine (Pontocaine ) or cocaine.
c. Preparation of the Patient. The patient is placed in a supine position, and
an assistant holds the patient's head in the proper position for good visualization of the
d. Operative Procedure.
(1) The spatula end of the laryngoscope is introduced into the right side of
the patient's mouth and directed toward the midline; then the dorsum of the tongue is
elevated, exposing the epiglottis.
(2) The patient's head is first tipped backward and then elevated and lifted
upward as the laryngoscope is advanced into the larynx.
(3) The larynx is examined, a biopsy is taken, secretions are aspirated, and
(4) The patient's face is cleansed. The patient is reassured and taken to his
room or the recovery room.
1-36. TONSILLECTOMY AND ADENOIDECTOMY
a. General. Tonsils and adenoids that are hypertrophied or chronically infected
are removed, which is called a tonsillectomy and adenoidectomy (T&A). Acute bacterial
infections can attack a ring of lymphoid tissue encompassing the tonsil and adenoid
tissue. Pain, malaise, anorexia, and increased temperature are typical symptoms.
b. Preparation of the Operating Room.
(1) The instruments in the setup include those needed for either sharp or
blunt dissection, according to the method preferred by the surgeon.
(2) The number of tonsil sponges, with cords attached for applying pressure
to the tonsil fossa, is included.