RESUMO
OBJECTIVES: Pediatric Obstructive Sleep Apnea (OSA) is associated with neurocognitive deficits. Cerebral structural alterations in the frontal cortex, cerebellum, and hippocampus have been reported in adult OSA patients. These brain areas are important for executive functioning, motor regulation of breathing, and memory function, respectively. Corresponding evidence comparing cerebral structures in pediatric OSA patients is limited. The objective of this study is to investigate MRI differences in cortical thickness and cortical volume in children with and without OSA. STUDY DESIGN: Prospective, single institutional case-control study. METHODS: Forty-five children were recruited at a pediatric tertiary care center (27 with OSA; mean age 9.9 ± 1.9 years, and 18 controls; mean age 10.5 ± 1.0 years). The OSA group underwent magnetic resonance imaging (MRI), polysomnography (PSG) and completed the Pediatric Daytime Sleepiness Scale (PDSS) and the Child's Sleep Habits Questionnaire (CSHQ). High-resolution T1-weighted MRI was utilized to examine cortical thickness and gray and white matter volume in children with OSA compared to a healthy group of demographically-comparable children without OSA selected from a pre-existing MRI dataset. RESULTS: Children with OSA showed multiple regions of cortical thinning primarily in the left hemisphere. Reduced gray matter (GM) volume was noted in the OSA group in multiple frontal regions of the left hemisphere (superior frontal, rostral medial frontal, and caudal medial frontal regions). Reduced white matter (WM) volume in both the left and right hemisphere was observed in regions of the frontal, parietal, and occipital lobes in children with OSA. CONCLUSION: This study noted differences in cortical thickness and GM and WM regional brain volumes in children with OSA. These findings are consistent with other pediatric studies, which also report differences between healthy children and those with OSA. We found that the severity of OSA does not correlate with the extent of MRI alterations.
Assuntos
Espessura Cortical do Cérebro , Substância Cinzenta/patologia , Apneia Obstrutiva do Sono/patologia , Substância Branca/patologia , Estudos de Casos e Controles , Criança , Feminino , Substância Cinzenta/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Tamanho do Órgão , Polissonografia , Estudos Prospectivos , Apneia Obstrutiva do Sono/diagnóstico por imagem , Substância Branca/diagnóstico por imagemRESUMO
Professionalism, quality, and safety have become essential components of pediatric otolaryngology. Professionalism, as defined by Osler, refers to the long tradition of physicians carrying out the noble cause of providing health care to patients and families. The importance of professionalism cannot be overstated and now is widely understood to be a core competency of every practicing physician. The attention to quality and safety is also a central tenet of current surgical practice. Quality is doing the right thing at the right time for the right persons. Safety is providing care to patients that is free from undue harm.
Assuntos
Competência Clínica , Otorrinolaringologistas , Otolaringologia/normas , Segurança do Paciente , Profissionalismo , Criança , Inteligência Emocional , Humanos , Cultura Organizacional , Otolaringologia/métodos , Melhoria de Qualidade/organização & administraçãoRESUMO
BACKGROUND: Recurrent Respiratory Papillomatosis (RRP) is a rare disease characterized by the growth of papillomas in the airway and especially the larynx. The clinical course is highly variable among individuals and there is poor understanding of the factors that drive an aggressive vs an indolent course. METHODS: A convenience cohort of 339 affected subjects with papillomas positive for only HPV6 or HPV11 and clinical course data available for 1 year or more, from a large multicenter international study were included. Exploratory data analysis was conducted followed by inferential analyses with frequentist and Bayesian statistics. RESULTS: We examined 339 subjects: 82% were diagnosed prior to the age of 18 years, 65% were infected with HPV6, and 69% had an aggressive clinical course. When comparing age at diagnosis with clinical course, the probability of aggressiveness is high for children under five years of age then drops rapidly. For patients diagnosed after the age of 10 years, an indolent course is more common. After accounting for confounding between HPV11 and young age, HPV type was minimally associated with aggressiveness. Fast and Frugal Trees (FFTs) were utilized to determine which algorithms yield the highest accuracy to classify patients as having an indolent or aggressive clinical course and consistently created a branch for diagnostic age at ~5 years old. There was no reliable strong association between clinical course and socioeconomic or parental factors. CONCLUSION: In the largest cohort of its type, we have identified a critical age at diagnosis which demarcates a more aggressive from less aggressive clinical course.
Assuntos
Papillomavirus Humano 11/fisiologia , Papillomavirus Humano 6/fisiologia , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/virologia , Adulto , Fatores Etários , Pré-Escolar , Condiloma Acuminado/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Mães , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/cirurgia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/cirurgiaRESUMO
Emotional intelligence (EI) is the ability to recognize, understand, and manage emotions in yourself and in others. EI has long been recognized as a critical component for individual and organizational success within the business realm, and there is emerging evidence that enhancing EI is equally important in the medical setting. EI can improve interpersonal communications, enable constructive conflict resolution, and promote a culture of professionalism. As healthcare becomes increasingly team-based, proficiency in EI will be required to build consensus among multidisciplinary stakeholders, and effect change in attitudes and behaviors that result in improved patient safety and clinical outcomes. Based on the existing literature and the authors' experiences, these 12 tips provide practical suggestions on how to introduce EI into a medical curriculum. These tips have broad applicability, and can be implemented in courses on topics such as professionalism, leadership development, empathy, patient safety, or wellness.
Assuntos
Educação Médica/organização & administração , Inteligência Emocional , Atitude do Pessoal de Saúde , Feedback Formativo , Processos Grupais , Humanos , Equipe de Assistência ao Paciente/organização & administração , Aprendizagem Baseada em Problemas/organização & administração , Autoavaliação (Psicologia) , Ensino/organização & administraçãoRESUMO
Disruptive behaviors impede delivery of high-value health care by negatively impacting patient outcomes and increasing costs. Health care is brimming with potential triggers of disruptive behavior. Given omnipresent environmental and cultural factors such as constrained resources, stressful environments, commercialization, fatigue, unrealistic expectation of perfectionism, and burdensome documentation, a burnout epidemic is raging, and medical providers are understandably at tremendous risk to succumb and manifest these unprofessional behaviors. Each medical specialty has its own unique challenges. Radiology is not exempt; these issues do not respect specialty or professional boundaries. Unfortunately, preventive measures are too frequently overlooked, provider support programs rarely exist, and often organizations either tolerate or ineffectively manage the downstream disruptive behaviors. This review summarizes the background, key definitions, contributing factors, impact, prevention, and management of disruptive behavior. Every member of the health care team can gain from an improved understanding and awareness of the contributing factors and preventive measures. Application of these principles can foster a just culture of understanding, trust, support, respect, and teamwork balanced with accountability. The authors discuss these general topics along with specific issues for radiologists in the current medical environment. Patients, providers, health care organizations, and society all stand to benefit from better prevention of these behaviors. There is a strong moral, ethical, and business case to address this issue head-on. ©RSNA, 2018.
Assuntos
Segurança do Paciente/normas , Comportamento Problema , Qualidade da Assistência à Saúde/normas , Serviço Hospitalar de Radiologia/organização & administração , Atitude do Pessoal de Saúde , Comportamento Cooperativo , Humanos , Relações Interprofissionais , Cultura OrganizacionalRESUMO
OBJECTIVE: To identify characteristics in patients who undergo positive and negative bronchoscopy for a suspected airway foreign body (AFB). METHODS: Review medical records between 2008 and 2012. RESULTS: There were 145 patients who went to the operating room with the pre-bronchoscopy diagnosis of suspected AFB during the study period. There was an overall negative bronchoscopy rate of an average of 37%, with an annual range between 21% and 50%. The findings of history or suspicion of choking, asymmetric breath sounds, and wheezing were statistically more common in patients with an AFB. Chest roentograms (CXR) had a sensitivity and specificity of 62% and 57%. Twenty patients had a chest computed tomography (CT) scan, and 100% were clinically significant. Four CT scans were diagnostic of an AFB, and 16 patients avoided bronchoscopy after negative CT. CONCLUSIONS: In current clinical practice, it is difficult to identify patients with an AFB without performing bronchoscopy. This results in a significant number of negative bronchoscopes. Certain elements in the history and physical exam were more common in patients who were found to have an AFB. Our preliminary data suggest that chest CT scans may be useful to decrease the number of negative bronchoscopies.
Assuntos
Corpos Estranhos/cirurgia , Aspiração Respiratória/cirurgia , Sistema Respiratório/cirurgia , Adolescente , Obstrução das Vias Respiratórias/etiologia , Broncoscopia , Criança , Pré-Escolar , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Humanos , Lactente , Modelos Logísticos , Masculino , Radiografia Torácica , Aspiração Respiratória/complicações , Aspiração Respiratória/diagnóstico por imagem , Sons Respiratórios/etiologia , Sistema Respiratório/diagnóstico por imagem , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XRESUMO
Recurrent thyroid infections are rare in children. When present, patients should be evaluated for anatomic anomalies such as pyriform sinus fistulae. We describe a 12-year-old girl with history of recurrent thyroid abscesses secondary to a pyriform sinus fistula and managed with concurrent endoscopic ablation and incision and drainage.
Assuntos
Ablação por Cateter/métodos , Endoscopia/métodos , Fístula/cirurgia , Seio Piriforme/cirurgia , Doenças da Glândula Tireoide/cirurgia , Criança , Feminino , HumanosRESUMO
OBJECTIVE: The objective of this study is to investigate differences between esophageal foreign body removal performed during standard operating room hours and those performed after-hours in asymptomatic patients. METHODS: A retrospective chart review at a tertiary children's hospital identified 264 cases of patients with non-emergent esophageal foreign bodies between 2006 and 2011. Variables pertaining to procedure and recovery times, hospital charges, complications, length of stay, American Society of Anesthesiology (ASA) classification, and presence of mucosal injury were summarized and compared between cases performed during standard operating hours and those performed after-hours. RESULTS: Cases performed during standard hours had significantly longer average wait times compared with after-hours cases (13.1h versus 9.0h, p<0.001). No other clinical characteristics or outcomes were significantly different between groups. Longer wait times are not associated with mucosal injury or postoperative complications. CONCLUSION: There were no significant differences in procedure time, charges, or safety in after-hours removal of non-emergent esophageal foreign bodies compared to removal during standard operating hours. OR wait time was about 4h longer during standard hours compared with after-hours. This study could not assess the factors to determine the impact in differences in hospital resource utilization or work force, which may be significant between these two groups.
Assuntos
Esôfago/cirurgia , Corpos Estranhos/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Salas Cirúrgicas , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Primitive Myxoid Mesenchymal Tumor of Infancy (PMMTI) is a recently recognized locally aggressive myofibroblastic tumor. It is a low- to intermediate-grade fibroblastic malignancy with a high local recurrence rate but low metastatic potential and is composed of primitive spindled cells in a myxoid background. We present the eleventh reported case of PMMTI, occurring in the sinonasal tract of a 3-year old child. This case is novel in both the relatively older age of the child, the location of the tumor, and the role that immunohistochemical stains, and cytogenetic analysis played in differentiating it from similar diagnoses that differ considerably in their chemosensitivity and recurrence rates. Close collaboration between the pathologist and surgeon was crucial as different diagnoses would have led to vastly different treatment strategies for the patient.
Assuntos
Fibrossarcoma/diagnóstico , Doenças Raras/diagnóstico , Neoplasias de Tecidos Moles/diagnóstico , Pré-Escolar , Feminino , Fibrossarcoma/tratamento farmacológico , Fibrossarcoma/patologia , Fibrossarcoma/cirurgia , Humanos , Imuno-Histoquímica , Doenças Raras/tratamento farmacológico , Doenças Raras/patologia , Doenças Raras/cirurgia , Neoplasias de Tecidos Moles/tratamento farmacológico , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVES/HYPOTHESIS: Alterations in swallowing can occur after tracheotomy and can result in varying degrees of aspiration. In tracheotomized adult patients, use of a Passy Muir Speaking Valve (PMV) has been shown to decrease laryngeal penetration and aspiration of foods and liquids. The objective of this study was to determine if the PMV has a similar effect on laryngeal penetration and aspiration in tracheotomized children. STUDY DESIGN: This is a prospective case-control study. METHODS: Pediatric patients with tracheotomies who were able to tolerate the PMV were identified. Modified barium swallow (MBS) was performed with and without the PMV. Two consistencies, thin liquids and purées, were used. Two speech language pathologists (SLPs), who were blinded to the PMV status, reviewed the recorded MBSs. Three swallows of each consistency were graded on an 8 point Penetration-Aspiration Scale. Residue in the vallecula, piriform sinuses, and posterior pharyngeal wall was graded. RESULTS: Twelve patients were included for analysis. Laryngeal penetration and aspiration was decreased with purées over liquids (P = 0.5 and P = 0.005, respectively) with either the sham valve or the PMV. The presence of the PMV decreased piriform sinus residue (P = 0.01); however, it did not demonstrate a decrease in laryngeal aspiration or penetration. CONCLUSION: Unlike in adults, the presence of PMV did not decrease laryngeal aspiration or penetration in children with tracheotomies. It did, however, improve piriform sinus residue. LEVEL OF EVIDENCE: 3b.
Assuntos
Transtornos de Deglutição/etiologia , Laringe Artificial , Laringe/lesões , Aspiração Respiratória/prevenção & controle , Traqueostomia/efeitos adversos , Estudos de Casos e Controles , Criança , Pré-Escolar , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/fisiopatologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Laringe/cirurgia , Masculino , Projetos Piloto , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Traqueostomia/métodos , Resultado do TratamentoRESUMO
OBJECTIVES/HYPOTHESIS: To analyze the patterns of surgical frequency in pediatric patients undergoing surgery with CO(2) laser ablation for juvenile onset recurrent respiratory papillomatosis (JORRP). The hypothesis is that over time there is a high variability in surgical frequency independent of the use of an adjuvant therapy. STUDY DESIGN: Retrospective case review. METHODS: All pediatric patients treated surgically with the CO(2) laser for JORRP by two senior surgeons at a tertiary pediatric hospital over an 11-year period were evaluated. Regression analysis was performed. An online survey was conducted of the American Academy of Pediatric Otolaryngology membership on their practice patterns regarding JORRP. RESULTS: Twenty-nine patients were identified, and of those, 20 were included in regression analysis. Several distinct patterns were noted. Only five of the 20 patients (25%) had a constant rate of procedures throughout the observation period. Three (15%) of the patients had continual decrease and one (5%) of the patients had a continual increase in the surgical rate throughout the study period. Eleven (55%) had a fluctuation in the pattern of their recurrences. When queried on how they approach when to repeat intervention for JORRP patients, more than 16 responses were given, and the most common determinants included standard set interval, previous operative findings, and previous interval. CONCLUSIONS: The natural fluctuation in intersurgical intervals without the use of any adjuvant therapy confounds the use of intersurgical interval as an outcome measure for the success of adjuvant therapy. Accelerations and decelerations were noted but cannot be explained.
Assuntos
Terapia a Laser/métodos , Lasers de Gás/uso terapêutico , Infecções por Papillomavirus/cirurgia , Reoperação/estatística & dados numéricos , Infecções Respiratórias/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Terapia a Laser/estatística & dados numéricos , Masculino , Infecções por Papillomavirus/epidemiologia , Prognóstico , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Bilateral myringotomy and placement of ventilating tubes (BMT) is one of the most common pediatric surgical procedures in the United States. Many children who undergo BMT develop behavioral changes in the postanesthesia care unit (PACU) and require rescue pain medication. The incidence of these changes is lower in children receiving intraoperative opioids by the nasal, IM, or IV route compared with placebo. However, there are no data to indicate which route of administration is better. Our study was designed to compare the immediate postoperative analgesic and behavioral effects of 3 frequently used intraoperative techniques of postoperative pain control for patients undergoing BMT under general anesthesia. METHODS: One hundred seventy-one ASA physical status I and II children scheduled for BMT were randomized into 1 of 3 groups: group 1-nasal fentanyl 2 µg/kg with IV and IM saline placebo; group 2-IV morphine 0.1 mg/kg with nasal and IM placebo; or group 3-IM morphine 0.1 mg/kg with nasal and IV placebo. All subjects received a standardized general anesthetic with sevoflurane, N(2)O, and O(2) and similar postoperative care. The primary end point of the study was the pain scores measured by the Faces, Legs, Activity, Cry, and Consolability (FLACC) scale in the PACU. RESULTS: There were no significant differences in peak FLACC pain among the 3 groups (mean [95% CI] 2.0 [1.2-2.8] for intranasal fentanyl, 2.7 [1.7-3.6] for IV morphine, and 2.9 [2.1-3.7] for IM morphine, respectively). There were no differences in the scores on the Pediatric Anesthesia Emergence Delirium (PAED) scale, incidence of postoperative emergence delirium (PAED score ≥ 12), emesis, perioperative hypoxemia, or need for airway intervention, and postoperative rescue analgesia. There were also no differences in the duration of PACU stay or parental satisfaction among the groups. CONCLUSION: In this double-blind, double-dummy study, there was no difference in the efficacy of intranasal fentanyl, IM and IV morphine in controlling postoperative pain and emergence delirium in children undergoing BMT placement. The IM route is the simplest and avoids the potential for delays to establish vascular access for IV therapy and the risks of laryngospasm if intranasal drugs pass through the posterior nasopharynx and irritate the vocal cords.
Assuntos
Analgésicos Opioides/administração & dosagem , Comportamento Infantil/efeitos dos fármacos , Fentanila/administração & dosagem , Intubação Intratraqueal/efeitos adversos , Morfina/administração & dosagem , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Membrana Timpânica/cirurgia , Administração Intranasal , Fatores Etários , Analgésicos Opioides/efeitos adversos , Período de Recuperação da Anestesia , Tubos Torácicos , Criança , Pré-Escolar , Delírio/etiologia , Método Duplo-Cego , Feminino , Fentanila/efeitos adversos , Humanos , Lactente , Comportamento do Lactente/efeitos dos fármacos , Injeções Intramusculares , Injeções Intravenosas , Intubação Intratraqueal/instrumentação , Masculino , Morfina/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Texas , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: Failure to thrive (FTT) is a feature of children with Potocki-Lupski syndrome (PTLS) [duplication 17p11.2]. This study was designed to describe the growth characteristics of 24 subjects with PTLS from birth through age 5 years in conjunction with relevant physical features and swallow function studies. STUDY DESIGN: We evaluated 24 individuals with PTLS who were ascertained by chromosome analysis and/or array comparative genome hybridization. Clinical assessments included review of medical records, physical examination, otolaryngological examination, and swallow function studies. Measures of height and weight were converted to Z-scores. RESULTS: The mean weight-for-age and weight-for-length Z-scores at birth were lower (P < .01) than the reference standard and did not change with age. A history of poor feeding, hypotonia, and FTT were reported in 92%, 88%, and 71%, respectively. Individuals with hypotonia had lower weight-for-age and body mass index-for-age Z-scores (P = .01). Swallow function studies demonstrated at least one abnormality in all subjects. CONCLUSIONS: FTT is common in children with PTLS. We hypothesize that oropharyngeal dysphagia and hypotonia likely contribute to FTT in patients with PTLS and recommend that once a diagnosis is established, the individual be assessed for feeding and growth issues and be availed of oromotor therapy and nutritional services.
Assuntos
Transtornos de Deglutição/etiologia , Insuficiência de Crescimento/etiologia , Anormalidades Múltiplas , Pré-Escolar , Transtornos Cromossômicos , Duplicação Cromossômica , Hibridização Genômica Comparativa , Nutrição Enteral , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Síndrome de Smith-Magenis/complicações , Síndrome de Smith-Magenis/diagnóstico , Síndrome de Smith-Magenis/genética , Síndrome de Smith-Magenis/terapiaRESUMO
We conducted a retrospective case-series review to identify the various diagnoses of neoplasms of the nasal cavity and paranasal sinuses in a pediatric population. Our study group was made up of 54 children-23 boys and 31 girls, aged 8 months to 16 years (mean: 9 yr). All patients had been diagnosed with a tumor of the nasal cavity or paranasal sinuses between Jan. 1, 1955, and Dec. 31, 1999, at one of four university-based, tertiary care referral centers. We compiled data on tumoral characteristics (location, size, and histopathology), morbidity and mortality, and rates of recurrence. Lesions included adnexal neoplasm, ameloblastic fibro-odontoma, basal cell carcinoma, benign fibrous histiocytoma, blue nevus, chondrosarcoma, compound nevus, epithelioma adenoides cysticum, esthesioneuroblastoma, Ewing sarcoma, fibrosarcoma, giant cell granuloma, granulocytic sarcoma, hemangioma, hemangiopericytoma, Langerhans cell histiocytosis, lymphangioma, lymphoma, melanoma, neuroblastoma, neurofibroma, ossifying osteofibroma, osteochondroma, osteosarcoma, port wine stain, rhabdomyosarcoma, Spitz nevus, and xanthogranuloma. To the best of our knowledge, this is the largest such study of its kind to date. We believe that the large size of this study and the data on disease incidence will allow clinicians to be better informed of the differential diagnosis of neoplasms of the nasal cavity and paranasal sinuses in the pediatric population.
Assuntos
Cavidade Nasal , Neoplasias Nasais/epidemiologia , Neoplasias dos Seios Paranasais/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos RetrospectivosRESUMO
BACKGROUND: The immediate postoperative period after tonsillectomy and adenoidectomy, one of the most common pediatric surgical procedures, is often difficult. These children frequently have severe pain but postoperative airway edema along with increased sensitivity to the respiratory-depressant effects of opioids may result in obstructive symptoms and hypoxemia. Opioid consumption may be reduced by nonsteroidal antiinflammatory drugs, but these drugs may be associated with increased bleeding after this operation. Dexmedetomidine has mild analgesic properties, causes sedation without respiratory depression, and does not have an effect on coagulation. We designed a prospective, double-blind, randomized controlled study to determine the effects of intraoperative dexmedetomidine on postoperative recovery including pain, sedation, and hemodynamics in pediatric patients undergoing tonsillectomy and adenoidectomy. METHODS: One hundred nine patients were randomized to receive a single intraoperative dose of dexmedetomidine 0.75 microg/kg, dexmedetomidine 1 microg/kg, morphine 50 microg/kg, or morphine 100 microg/kg over 10 minutes after endotracheal intubation. RESULTS: There were no significant differences among the 4 groups in patient demographics, ASA physical status, postoperative opioid requirements, sedation scores, duration of oxygen supplementation in the postanesthetic care unit, and time to discharge readiness. The median time to first postoperative rescue analgesic was similar in patients receiving dexmedetomidine 1 microg/kg and morphine 100 microg/kg, but significantly longer compared with patients receiving dexmedetomidine 0.75 microg/kg or morphine 50 microg/kg (P < 0.01). In addition, the number of patients requiring >1 rescue analgesic dose was significantly higher in the dexmedetomidine 0.75 microg/kg group compared with the dexmedetomidine 1 microg/kg and morphine 100 microg/kg groups, but not the morphine 50 microg/kg group. Patients receiving dexmedetomidine had significantly slower heart rates in the first 30 minutes after surgery compared with those receiving morphine (P < 0.05). There was no significant difference in sedation scores among the groups. CONCLUSIONS: The total postoperative rescue opioid requirements were similar in tonsillectomy patients receiving intraoperative dexmedetomidine or morphine. However, the use of dexmedetomidine 1 microg/kg and morphine 100 microg/kg had the advantages of an increased time to first analgesic and a reduced need for additional rescue analgesia doses, without increasing discharge times.