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In Reply.—Our report demonstrates that adenoidectomy and tonsillectomy can be safely done as outpatient procedures. In our bismuth subgallate with epinephrine surgical technique, electrocautery, sutures, and ties are not used. Less tissue trauma is produced. If there is no medical contraindication, older children and adults receive perioperatively 8 to 12 mg of dexamethasone intravenously. The same dose is repeated prior to the patient's discharge. Steroids used in this manner reduce edema and tissue reaction, therefore minimizing pain and dysphagia, allowing for patients to go home the same day. Also, analgesics in liquid suspension (Tylenol with codeine or Demerol) are prescribed half an hour before meals. This postoperative management has been safe and effective in our hands.
The surgeon's judgment should prevail regarding the need for overnight admission. Insurance companies and/or third-party payers cannot dictate that every adenoidectomy and tonsillectomy must be done on an ambulatory basis.
ANTHONY J. MANIGLIA. Adenotonsillectomy: A Safe Outpatient Procedure-Reply. Arch Otolaryngol Head Neck Surg. 1989;115(6):749. doi:10.1001/archotol.1989.01860300103029