Childhood Adenotonsillectomy Trial

7.2.3 AT Guidelines

The RC will notify the surgeon when a study patient is scheduled for surgery and ensure the data collection form is available. To monitor surgical consistency, the surgeon will complete intra-operative data sheets (Attachment B: OPER) on each study patient at the time of surgery documenting surgical technique, blood loss, size of tonsils and adenoids pre-operatively, whether or not tonsils were entirely removed and degree of residual adenoid obstruction postoperatively as well as any intra or peri-operative complications.

In the operating room patients will be orally intubated and general anesthesia will be administered.

Tonsil size will be graded as:

• 1 taking up 0-25 % of airway
• 2 taking up 26-50 % of airway
• 3 taking up 51-75 % of airway
• 4 taking up 76-100% of airway

Board-certified otolaryngologists, with or without the participation of resident physicians in accredited otolaryngology training programs, will then remove the right and left tonsils entirely using either cold dissection or mono-polar electro cautery and obtain hemostasis. The soft palate will then be inspected and palpated to assure there is no evidence of a submucus cleft palate. The palate will be retracted. The naso-pharynx and adenoid tissue will be inspected and graded as mildly (0-33%), moderately (33-66%) or severely (67-100%) obstructing the posterior choanae. The obstructing portions of adenoid tissue will be removed using either cold dissection or monopolar electro cautery and hemostasis will be obtained. The intra-operative data sheet will then be completed and collected by the unblinded coordinator.