a) Considerations of airway obstruction, shared airway, mechanical suspension of the airway, management of intubation and extubation, pain management, and the desire for a rapid awakening are all subtleties of anesthesia that challenge the anesthesia provider.

b) In adult patients, a tonsillectomy may also accompany a uvulopalatopharyngoplasty (UPPP) for Pickwickian syndrome or OSA. OSA is typically seen with obesity and redundant pharyngeal tissue. Patients with OSA can also present with a history of right heart failure, cor pulmonale, and congestive heart failure, which is not uncommon.

c) The patient undergoing a tonsillectomy or adenoidectomy will probably have a higher incidence of airway obstruction because of the hypertrophied tissues. Chronic obstruction and infections of the tonsils can lead to potential systemic involvement, producing additional cardiac and respiratory anomalies.

d) In the case of suspected airway obstruction, the clinician must choose wisely among routine IV induction, inhalation induction, awake intubation, or fiberoptic-assisted intubation before induction. Adult patients with severe OSA may require a tracheostomy under local anesthesia in advance to secure the airway before the induction of general anesthesia. Such determination is based on the degree of obstruction, physical examination of the airway, and clinical judgment of the anesthesia provider. Regardless of the induction technique chosen, the use of an antisialagogue is strongly encouraged to reduce oral secretion to improve visualization during intubation and surgery.

e) In children, anesthesia is usually induced with an inhalation agent, oxygen, with or without N₂O by mask. Some institutions allow parental presence in the operating room during induction to prevent separation anxiety in the child. Tracheal intubation in children is best accomplished under deep inhalation anesthesia or aided by a short-acting nondepolarizing muscle relaxant. The airway generally is secured with an oral RAE or reinforced tube. A cuffed tube is recommended in patients older than 8 to 10 years of age, with continued attention to inflation pressures of the cuff. A properly sized pediatric ETT should allow a leak at 20 cm H₂O airway pressure, which reduces the likelihood of postoperative croup and tracheal edema. The tube must be secured midline. A simple yet effective method of securing the oral RAE tube is to apply a strip of tape directly to the chin, incorporating the ETT and another strip of tape over the tube. The first strip provides a secure base for the second strip, which actually holds the tube.