Early post-operative fever following tonsillectomy: a possible cause and management

Tonsillectomy/adenotonsillectomy is routinely performed in the practice of otolaryngology, however, the aetiology of the low-grade early post-operative fever [1-3 days] remains todate obscure. Bacteraemia during surgery, anaesthetic agents and the inflammatory response to tissue injury have been speculated but without a conclusive evidence. In the current study, we looked into the inhalation and ingestion of blood during the surgical procedure as an aetiological factor. A prospective study in 350 children undergoing tonsillectomies or adenotonsillectomies was performed during two-year duration from January 2003 to January 2005 at Misr University. In all cases, the amount of blood inhaled was assessed immediately following the operation by passing a small rigid bronchoscope and aspirating all blood inhaled during surgery after gaining the parents consent, while faecal occult blood looked for the ingested blood in all cases. It was found that a few milliliters [1-5 ml] of blood do actually find their way to the trachea especially if non-cuffed endotracheal tube is used. On the other hand, the stool of the patients who head early post-operative fever following tonsillectomy [35 cases out of 350 i.e.10%], showed a significant amount of occult red blood cells in 31 patients out of the 35 i.e.88.5%. Moreover a 3 days course of 660 mg/day of nifuroxazide [Antinal] the intestinal antiseptic drug, in three divided doses was effective in the fever relief. Our results indicate that ingested blood during surgery may activate the intestinal pathogenic organisms with subsequent gastroenteritic reaction resulting into this low to moderate grade post-operative fever, despite the fact that there was no change in bowel motion. This highlights the importance of packing the pharynx to minimize the amount of blood ingested during surgery, and the use of antinal to tackle this post-operative fever if existed