A child with grade IV tonsillar hypertrophy (tonsils meeting in midline) and recurrent tonsillitis (7 episodes in the past year) is brought for assessment. His parents are concerned about anaesthetic risk because the child had a prolonged QT interval on a pre-operative ECG. The most appropriate next step is:
- A Refer to paediatric cardiology for evaluation before proceeding with tonsillectomy ✓
- B Proceed immediately with tonsillectomy under general anaesthesia
- C Cancel surgery and manage with long-term antibiotic prophylaxis
- D Perform tonsillotomy under local anaesthesia to avoid general anaesthesia risk
Correct answer: A. Refer to paediatric cardiology for evaluation before proceeding with tonsillectomy
Explanation
A prolonged QT interval on ECG represents a potential risk for fatal perioperative arrhythmias (torsades de pointes) under volatile anaesthetic agents such as sevoflurane, which also prolong QTc. The appropriate step is cardiology evaluation to determine the aetiology (congenital long QT syndrome vs drug-induced vs electrolyte) and receive clearance or a modified anaesthetic protocol before surgery. Neither emergency proceeding nor indefinite cancellation is appropriate given this child's valid surgical indications.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.