Tonsillectomy is one of the most common surgical procedures performed in children in the United States. Indications and recommendations for perioperative management are multiple and may vary among clinicians. Although tonsillectomy is a safe procedure, it can be associated with morbidity. Several techniques have been developed to reduce perioperative complications, but evidence of this reduction is lacking. This article provides clinicians with evidence-based guidance on perioperative clinical decision making and surgical technique for tonsillectomy.