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1.
Medicine (Baltimore) ; 99(6): e19004, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028411

RESUMO

BACKGROUND: Endoscopic tonsillectomy is associated with postoperative pain. Postoperative pain management remains to be improved in children. We aimed to investigate oxycodone preemptive analgesia in children undergoing endoscopic plasma total adenotonsillectomy. METHODS: 166 children with adenotonsillar hypertrophy were recruited at Wuhan Children's Hospital between 08/2016 and 03/2017. They were randomly assigned to receive SPOA (postoperative sufentanil), SPEA+SPOA (preemptive sufentanil and postoperative sufentanil), and OPEA+SPOA (preemptive oxycodone and postoperative sufentanil). The primary endpoint was serum c-fos levels. The secondary endpoints were the response entropy (RE) value, Pediatric Anesthesia Emergence Delirium (PAED) score, FLACC score, and adverse events. RESULTS: c-fos mRNA levels were increased significantly after surgery in the SPOA and SPEA+SPOA groups (P < .05). Postoperatively, c-fos mRNA levels were higher in the SPOA group compared with the OPEA+SPOA group (P = .044). The RE values increased in all groups after surgery (P < .05). At extubation, RE values were higher in the SPOA group compared with the SPEA+SPOA and OPEA+SPOA groups (P < .05). The PAED scores were higher in the SPOA group compared with the OPEA+SPOA group (P = .045). In the SPOA group, the FLACC scores were decreased at 24 h after surgery vs 4 hours (P = .044). Prediction probability (Pk) values indicated that RE and c-fos mRNA levels were quantitative predictors for early postoperative stress reaction after surgery. CONCLUSIONS: The subanalgesic dose of oxycodone (0.1 mg/kg) as preemptive analgesia could improve pain after endoscopic plasma total adenotonsillectomy in children.


Assuntos
Adenoidectomia , Analgésicos Opioides/uso terapêutico , Oxicodona/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Tonsilectomia , Actinas/sangue , Adenoidectomia/efeitos adversos , Adenoidectomia/métodos , Criança , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Humanos , Masculino , Proteínas Proto-Oncogênicas c-fos/sangue , Reação em Cadeia da Polimerase em Tempo Real , Sufentanil/uso terapêutico , Tonsilectomia/efeitos adversos , Tonsilectomia/métodos
2.
J Pediatr Ophthalmol Strabismus ; 56: e76-e78, 2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31821512

RESUMO

Ocular complications of adenotonsillectomy are rare. The authors describe a 6-year-old boy who developed mydrasis and limitations of supraduction and infraduction after adenotonsillectomy. This was attributed to the hemorrhagic compression of the nerve in the cavernous sinus. This is the first report of pupil-involving oculomotor nerve palsy following adenotonsillectomy. [J Pediatr Ophthalmol Strabismus. 2019;56:e76-e78.].


Assuntos
Adenoidectomia/efeitos adversos , Movimentos Oculares/fisiologia , Midríase/etiologia , Doenças do Nervo Oculomotor/etiologia , Nervo Oculomotor/fisiopatologia , Pupila/fisiologia , Tonsilectomia/efeitos adversos , Criança , Humanos , Imagem por Ressonância Magnética , Masculino , Midríase/diagnóstico , Midríase/fisiopatologia , Doenças do Nervo Oculomotor/diagnóstico , Doenças do Nervo Oculomotor/fisiopatologia , Complicações Pós-Operatórias
3.
Int. arch. otorhinolaryngol. (Impr.) ; 23(4): 403-407, Out.-Dez. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1024212

RESUMO

Introduction: Tonsillectomy is one of the most common otolaryngology procedures performed worldwide. It is also one of the first procedures learnt by residents during their training period. Although tonsillectomy is viewed relatively as a low-risk procedure, it can be potentially harmful because of the chance of posttonsillectomy hemorrhage. Objective: The objective of the present study is to analyze the effects of peroperative factors and experience of the surgeon on the incidence and pattern of posttonsillectomy reactionary hemorrhage. Methods: A retrospective review of medical charts was performed from 2014 to 2017 in a tertiary care hospital. A total of 1,284 patients who underwent tonsillectomy and adenoidectomy were included in the study. The parameters assessed were experience of the surgeon, operating time, intraoperative blood loss, difference in mean arterial pressure (MAP) and pulse rate. Results: A total of 23 (1.79%) out of the 1,284 patients had reactionary hemorrhage. Out of those 23, 16 (69.5%) patients had been operated on by trainees, while 7 (30.5%) had been operated on by consultants (p = 0.033, odds ratio [OR] = 0.04). Operating time, intraoperative blood loss, difference in MAP and pulse rate were significantly higher in the reactionary hemorrhage group, and showed a positive association with risk of hemorrhage (p < 0.05; OR >1). Re-exploration to control the bleeding was required in 10 (76.9%) out of the 23 cases. Conclusion: The experience of the surgeon experience and peroperative factors have an association with posttonsillectomy hemorrhage. Close surveillance and monitoring of the aforementioned peroperative factors will help in the identification of patients at risk of hemorrhage (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Tonsilectomia/efeitos adversos , Hemorragia Pós-Operatória/etiologia , Pulso Arterial , Estudos Retrospectivos , Fatores de Risco , Perda Sanguínea Cirúrgica , Hemorragia Pós-Operatória/terapia , Duração da Cirurgia , Pressão Arterial , Hospitais Universitários , Período Intraoperatório
4.
Anaesthesia ; 74(12): 1572-1579, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31508815

RESUMO

Adenotonsillectomies are commonly performed procedures and sleep-disordered breathing is becoming increasingly important as an indication for surgery. Because of the higher risks in patients with obstructive sleep apnoea, the required level of postoperative care for these patients is currently under discussion, and better identification of patients at risk may reduce unnecessary postoperative monitoring. To evaluate the influence of obstructive sleep apnoea, and other risk factors, on peri-operative complications in children requiring adenotonsillectomy, we performed a retrospective case-control study that included 1995 patients treated between January 2009 and June 2017. In our analysis, young age (OR 3.8, 95%CI 2.1-7.1), low body weight (OR 2.6, 95%CI 1.5-4.4), obstructive sleep apnoea (OR 2.4, 95%CI 1.5-3.8), pre-existing craniofacial or syndromal disorders (OR 2.3, 95%CI 1.4-3.8) and adenotonsillectomy, compared with adenoidectomy alone, (OR 7.9, 95%CI 4.7-13.1) were identified as risk factors for complications during or after surgery, p < 0.001. All 13 patients suffering from complications more than 3 h postoperatively had obstructive sleep apnoea plus at least one more of these risk factors. Patients at risk of postoperative complications can therefore be identified by several criteria pre-operatively, and should be monitored postoperatively using pulse oximetry overnight. For all other patients, postoperative observation on a surgical ward without extra monitoring is sufficient. Admission to paediatric intensive care should be reserved for patients suffering serious intra-operative complications.


Assuntos
Adenoidectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Tonsilectomia/efeitos adversos , Adenoidectomia/estatística & dados numéricos , Adolescente , Fatores Etários , Peso Corporal , Estudos de Casos e Controles , Criança , Pré-Escolar , Anormalidades Craniofaciais/complicações , Feminino , Humanos , Lactente , Masculino , Monitorização Fisiológica , Oximetria , Estudos Retrospectivos , Fatores de Risco , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/epidemiologia , Tonsilectomia/estatística & dados numéricos
5.
Int J Pediatr Otorhinolaryngol ; 127: 109668, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31526936

RESUMO

INTRODUCTION: The complications of tonsillectomy and adenoidectomy (T&A) are well-described and include bleeding, dehydration, nausea, respiratory complications, and pain. After the immediate postoperative phase, the overall 30-day emergency department (ED) return rate is as high as 13.3%. However, few studies have examined the types and rates of late post-operative complications for children undergoing T&A stratified base on patient age. Herein, we aim to better characterize ED return visits for children of all ages, with special attention to those patients under three years of age. METHODS: This is a retrospective case series at a tertiary academic pediatric medical center. All patients 18 years of age or younger who underwent T&A over eighteen months were included. Data including ED return diagnosis, post-operative day of presentation, and need for surgical intervention was recorded for patients who presented to the ED within 30 days of their original surgery. RESULTS: 5,225 patients were identified, with an overall late complication rate of 12.8%. There was no difference in the 30-day ED readmission rate for children under the age of three, although children under the age of two were more likely to present to the ED. There was a significantly higher risk of dehydration for children under the age of four years, and a significantly higher bleeding risk and need for reoperation for control of post-tonsillectomy hemorrhage (PTH) for children over the age of six. CONCLUSIONS: The overall ED visit rate in this study is 12.8%, with no difference based on age. Patients younger than three years of age are more likely to return to ED for dehydration, while bleeding and need for control of oropharyngeal hemorrhage is more common in older children. Knowledge of the age-related late complications of T&A may direct appropriate anticipatory peri-operative counseling of risks and return precautions.


Assuntos
Adenoidectomia/efeitos adversos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Hemorragia Pós-Operatória/etiologia , Tonsilectomia/efeitos adversos , Adolescente , Fatores Etários , Idoso , Criança , Pré-Escolar , Desidratação/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Hemorragia Pós-Operatória/cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
7.
Eur Arch Otorhinolaryngol ; 276(11): 3231-3238, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31377901

RESUMO

PURPOSE: Our previous randomized controlled trial (RCT) of children with obstructive sleep apnea (OSA) showed no significant differences between adenotonsillectomy (ATE) and adenotonsillomy (ATE) in improving nocturnal respiration and symptoms after one year. This is the continuous report with the evaluation of postoperative morbidity concerning bleeding and pain. METHODS: A double-blinded RCT including 79 children, aged 2-6 years, with moderate to severe OSA, randomized to either ATE (n = 40) or ATT (n = 39). From one to ten days postoperatively, parents filled in a logbook with six pain-related outcomes (parent and child grading pain at different levels, days of analgesic use and return to normal diet). Peri- and postoperative bleeding were also registered. RESULTS: 63 patients (80%) returned the logbook. There were significant differences between groups in only two of the six pain-related outcomes in favor of the ATT group; first day when the children graded themselves as pain free (p = 0.021, Log Rank Test), and first day the caregiver estimated pain VAS ≤ 5 (p = 0.007, Log Rank Test). Two (5%) cases of postoperative bleeding occurred in the ATE group, one of which needed a return to theatre. No case of postoperative bleeding was seen in the ATT group. CONCLUSIONS: The results from this RCT are in line with previous comparative studies between ATT and ATE. Children operated with ATT had significantly less postoperative pain in one-third of the outcomes, and less bleeding than ATE. However, as the differences in morbidity between the surgical methods were minor the clinical significance is uncertain. TRIAL REGISTRATION: This study was approved by the Swedish Regional Ethics Board in Stockholm, Sweden (Dnr 2011/925-32 and 2013/2274-32) and registered at ClinicalTrials.gov (Trial registration number NCT01676181).


Assuntos
Acetaminofen/administração & dosagem , Adenoidectomia , Dor Pós-Operatória , Hemorragia Pós-Operatória , Tonsilectomia , Adenoidectomia/efeitos adversos , Adenoidectomia/métodos , Analgésicos não Entorpecentes/administração & dosagem , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Masculino , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Apneia Obstrutiva do Sono/fisiopatologia , Tonsilectomia/efeitos adversos , Tonsilectomia/métodos , Resultado do Tratamento
8.
Eur Arch Otorhinolaryngol ; 276(9): 2585-2593, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31256244

RESUMO

PURPOSE: To evaluate whether changing trends in tonsil surgery between 2005 and 2017 in Germany were associated with different age- and gender-specific hemorrhage rates. METHODS: A longitudinal population-based inpatient cohort study was performed including all patients who had undergone tonsillectomy (with or without adenoidectomy), tonsillotomy, abscess-tonsillectomy, removal of tonsillar remnants and surgical treatment to achieve hemostasis following tonsil surgery. The population was stratified by age (groups of 5 years) and gender. Operation rates were calculated in relation to the end-year population number according to the German Federal Office of Statistics. RESULTS: The surgical rates per 100,000 had significantly decreased from 170.39 to 90.95 (46.62%) in female patients and from 147.33 to 88.19 (40.14%) in male patients within the study period (p < 0.001). A total of 42.352 female patients had required surgical treatment to achieve hemostasis following 783,005 procedures (5.41%). In contrast, only 669,632 operations were performed in male patients but were complicated by hemorrhage in 51.185 cases (7.64%) which was significantly different (p < 0.001). The male-to-female ratio of the surgical rates had increased from 0.86:1 to 0.93:1. Hemorrhage rates differed significantly between age groups (p < 0.001). Male gender is a significant risk factor for bleeding at all ages < 85 years with greatest differences in 20- to 25-year-old patients (12.19% male vs. 6.26% female). CONCLUSIONS: Changing trends in tonsil surgery are not associated with increased rates of bleeding complications. Hemorrhage following tonsil surgery is significantly related to age and gender and this should be noted when reported hemorrhage rates in the literature are appraised by the reader.


Assuntos
Hemostasia Cirúrgica , Doenças Faríngeas/cirurgia , Hemorragia Pós-Operatória , Tonsilectomia , Adolescente , Adulto , Fatores Etários , Idoso de 80 Anos ou mais , Pré-Escolar , Estudos de Coortes , Feminino , Alemanha/epidemiologia , Hemostasia Cirúrgica/métodos , Hemostasia Cirúrgica/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Doenças Faríngeas/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/cirurgia , Fatores de Risco , Fatores Sexuais , Tonsilectomia/efeitos adversos , Tonsilectomia/métodos , Tonsilectomia/tendências
9.
J Laryngol Otol ; 133(7): 615-621, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31296273

RESUMO

OBJECTIVE: A single-centre, single-blinded prospective experimental study was conducted to determine the effectiveness of autologous platelet-rich plasma applied to the tonsillar bed post-operatively in reducing post-operative pain and haemorrhage. METHODS: Platelet-rich plasma, prepared prior to surgery, was applied with calcium gluconate to one randomly chosen tonsillar fossa. Pain and haemorrhage were analysed, using a visual analogue scale and a pre-defined grading scale respectively, four times on the day of surgery at 2-hourly intervals, and thrice on the following day. RESULTS: The pain score and haemorrhage grade on the test side were lower than on the control side. These findings were statistically significant. CONCLUSION: This pilot study, conducted in India, revealed valid positive results for a promising new technology. The manual preparation of platelet-rich plasma could be automated in the future to allow a larger sample size.


Assuntos
Analgesia/métodos , Dor Pós-Operatória/terapia , Plasma Rico em Plaquetas/citologia , Hemorragia Pós-Operatória/terapia , Tonsilectomia/efeitos adversos , Adolescente , Adulto , Autoenxertos , Gluconato de Cálcio/administração & dosagem , Criança , Feminino , Hemostasia , Humanos , Masculino , Manejo da Dor , Projetos Piloto , Transfusão de Plaquetas , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
10.
Eur Arch Otorhinolaryngol ; 276(9): 2595-2601, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31300842

RESUMO

PURPOSE: The treatment of peritonsillar abscess (PTA) is still controversial regarding the best method of drainage to perform. This study aims to compare effectiveness and safety of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of PTA. METHODS: A retrospective review of patients (age > 15 years) admitted in two tertiary medical centres for a PTA between November 2010 and October 2016 was performed. Patients were divided into two groups according to the type of drainage: needle aspiration or incision and drainage, under local anaesthesia. The primary outcome was the length of hospital stay; the need to repeat the procedure or to go to the operating room was also assessed. Complications or adverse events were listed in each group to assess safety. RESULTS: Over a 6-year period, 182 patients were admitted for a PTA and included in the analysis, with 82 patients in the aspiration group and 100 patients in the incision group. Mean age was 36.3 years, with a sex ratio of 1.33. The length of hospital stay ranged from 1 to 7 days (mean 2.7 days, median 2 days) with a median length of stay of 3.0 days (interquartile range 2-4) in the aspiration group versus 2.0 days (IQR 2-3) in patients who underwent incision and drainage (p = 0.009). A repetition of the needle aspiration was made for 46.3% of patients versus 10% of repetition of the procedure in the incision group (p = 0.0001). 12 patients (14%) of the aspiration group and 4 patients (4%) of the incision group required an additional drainage under general anaesthesia (p < 0.001). We found no differences regarding safety in both groups. CONCLUSION: Our study showed a significant decrease in the length of hospital stay in patients admitted for a PTA who underwent an initial incision and drainage under local anaesthesia, compared to needle aspiration, as well as a lower risk of repeating the procedure. A well-designed prospective and randomized study on a larger sample of patients is required to support these findings.


Assuntos
Paracentese , Abscesso Peritonsilar/cirurgia , Complicações Pós-Operatórias , Tonsilectomia , Adulto , Anestesia Local/métodos , Drenagem/métodos , Feminino , França/epidemiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Paracentese/efeitos adversos , Paracentese/métodos , Abscesso Peritonsilar/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Tonsilectomia/efeitos adversos , Tonsilectomia/métodos
11.
Int J Pediatr Otorhinolaryngol ; 125: 141-146, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31306896

RESUMO

OBJECTIVES: 1. To compare outcomes after tonsillectomy for pediatric patients with obstructive sleep apnea (OSA) given morphine intra-operatively and post operatively compared to those who were not - specifically Recovery Room (RR) time, length of stay (LOS), Emergency Department (ER) visits. STUDY DESIGN: Retrospective case series with chart review. SETTING: Tertiary care children's hospital. SUBJECTS AND METHODS: All children between 1 and 17 years old who had undergone tonsillectomy in a single institution from 2013 to 2016. Comparison between children who had received morphine intra-operatively was made for outcomes. RESULTS: 556 patients were included, 73 patients had morphine intraoperatively and 483 did not; these latter children were older (8.8 vs 6.5 years, P < 0.001), and had fewer episodes of obstructive apnea and hypopnea (AHI 4.47 vs 10.15, p = 0.003) than children who did not receive intra-op morphine. There were no differences in co-morbidities including asthma, whether they had a sleep study, time in the operating room, emergence time, RR time, airway complications, IMC/PICU admission for respiratory distress, ER visits, readmissions, bleeding or post-discharge nurse phone calls. There was a longer LOS (25.9 vs 21.4 h, P = 0.011) for the group receiving intra-op morphine. CONCLUSION: Children with OSA who receive intra-op morphine have a longer LOS suggesting that its use should be examined more closely in this population.


Assuntos
Adenoidectomia/efeitos adversos , Analgésicos Opioides/administração & dosagem , Morfina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Apneia Obstrutiva do Sono/cirurgia , Tonsilectomia/efeitos adversos , Adolescente , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Hospitalização , Humanos , Lactente , Tempo de Internação , Masculino , Dor Pós-Operatória/etiologia , Polissonografia , Estudos Retrospectivos , Resultado do Tratamento
12.
Int J Pediatr Otorhinolaryngol ; 124: 173-178, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31202034

RESUMO

OBJECTIVE: To understand parent perceptions of post-operative narcotic use in the pediatric otolaryngology patient population. METHODS: This was a descriptive survey of caregivers on children being seen in a university pediatric otolaryngology clinic. Caregiver role, age of child, previous exposure to analgesics, choice of analgesics, comfort and concern with narcotic use in this child, knowledge of narcotic side effects, and knowledge about narcotic disposal were included. Comfort and concern questions were scored on a 10-point VAS where the higher numbers indicated more concern/discomfort. RESULTS: 301 caregivers participated, 84.5% were mothers, 11% were fathers and the rest were custodial grandparents. 45.2% knew someone addicted to narcotics. Respondents were uncomfortable with their child experiencing pain in a hypothetical postoperative situation, with 63.9% having at least some discomfort with it. First choice of medication to treat hypothetical post-tonsillectomy pain was ibuprofen (47.5%) followed by acetaminophen (38.9%). 29.9% were concerned about addiction, and 26.6% were concerned about drowsiness as a sequela of narcotic use. There were significant differences between respondents who knew a person addicted to narcotics and those who did not for comfort using narcotics in their child (VAS median 6.0 versus 5.0, p = 0.025), concern that their child would become addicted to narcotics (VAS median 5.0 versus 2.0, p = 0.001), concern about side effects (VAS median 7.0 versus 6.0, p = 0.007) and concern about having narcotics in the home (VAS median 3.0 versus 0.0, p < 0.001). CONCLUSIONS: The national opioid epidemic exposes more parents to narcotic addiction in the community, which affects their perceptions of pediatric post-operative narcotic use. These experiences may need to be considered when planning postoperative pain management strategies in children.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Entorpecentes/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Pais/psicologia , Tonsilectomia/efeitos adversos , Acetaminofen/uso terapêutico , Adolescente , Analgésicos não Entorpecentes/uso terapêutico , Cuidadores/psicologia , Criança , Pré-Escolar , Feminino , Humanos , Ibuprofeno/uso terapêutico , Lactente , Masculino , Transtornos Relacionados ao Uso de Opioides , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Inquéritos e Questionários
13.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 33(6): 565-566;576, 2019 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-31163538

RESUMO

Summary The patient was admitted with the complain about sleep snoring with suffocation last for half a year. Adenotonsillectomy was performed. Preoperative examination showed that there was no respiratory infection, or other surgical contraindications. The process of operation was successful. One day after surgery, the child developed chest pain and fever. Chest CT showed left lobar pneumonia. After Bronchoscopy and alveolar lavage and antibiotic use, the symptom was improved. General anesthesia and surgery were the cause of pneumonia. This case showed the association between lower respiratory tract infection and obstructive pathophysiological changes in the upper respiratory tract, and the possibility of complicated lobar pneumonia after adenotonsillectomy in children with OSA..


Assuntos
Adenoidectomia , Pneumonia , Apneia Obstrutiva do Sono , Tonsilectomia , Adenoidectomia/efeitos adversos , Criança , Humanos , Pneumonia/etiologia , Apneia Obstrutiva do Sono/cirurgia , Ronco , Tonsilectomia/efeitos adversos
14.
Artigo em Chinês | MEDLINE | ID: mdl-31163546

RESUMO

Objective: To investigate the risk factors for postoperative haemorrhage following coblation assisted tonsillectomy, thus provide the guidence for the clinical treatment. Method: The clinical data of 1 128 patients who underwent tonsillectomy were analyzed retrospectively. Result: The rate of postoperative haemorrhage was 6.02%. Univariate analysis and logistic regression analysis showed a significant relationship between age and postoperative haemorrhage(P<0.05). Conclusion: Age was an independent risk factor for postoperative haemorrhage following coblation-assisted tonsillectomy. .


Assuntos
Hemorragia Pós-Operatória , Tonsilectomia/efeitos adversos , Humanos , Estudos Retrospectivos , Fatores de Risco
15.
J Laryngol Otol ; 133(6): 520-525, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31172898

RESUMO

BACKGROUND: Tonsillectomy is one of the most common otolaryngological procedures. Nonetheless, there is still no universally approved 'gold standard' technique. OBJECTIVE: To compare the safety and efficacy of argon plasma coagulation and coblation techniques in tonsillectomy. METHODS: A multi-institutional, retrospective cohort study was conducted, comprising 283 patients who underwent bilateral tonsillectomies performed by a single surgeon between 2014 and 2017. The outcome measures included: operative time, intra-operative blood loss, post-operative pain and post-operative haemorrhage. RESULTS: In the argon plasma coagulation group, mean operative time and post-operative haemorrhage rate were significantly reduced, p = 0.0006 and p = 0.003 respectively. There was no statistically significant difference between the two groups in terms of post-operative pain and intra-operative blood loss. CONCLUSION: The argon plasma coagulation technique is easy, safe and efficacious. Argon plasma coagulation tonsillectomy seems cost-effective compared to coblation tonsillectomy: the single-use disposable electrode tip and wand used in this study cost AUD$76.50 and AUD$380 respectively. Argon plasma coagulation appears to be a favourable alternative to current modalities such as coblation.


Assuntos
Coagulação com Plasma de Argônio/métodos , Tempo de Internação , Segurança do Paciente , Tonsilectomia/métodos , Adolescente , Fatores Etários , Coagulação com Plasma de Argônio/efeitos adversos , Austrália , Perda Sanguínea Cirúrgica , Criança , Pré-Escolar , Estudos de Coortes , Criocirurgia/métodos , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Lactente , Masculino , Duração da Cirurgia , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/fisiopatologia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Tonsilectomia/efeitos adversos , Resultado do Tratamento , Adulto Jovem
16.
Am J Otolaryngol ; 40(5): 667-672, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31174930

RESUMO

OBJECTIVES: As the incidence of autism spectrum disorder (ASD) increases, otolaryngologists are more likely to encounter patients from this population during tonsillectomy. The purpose of this study was to examine whether outcomes differ between pediatric patients with and without ASD in a national cohort of children undergoing tonsillectomy. Understanding these differences may be used to inform future approaches to improve clinical outcomes and healthcare costs. METHODS: Data for this study were obtained from the Kids Inpatient Database (KID) of the Healthcare Cost Utilization Project. We studied pediatric patients who underwent tonsillectomy during 2003, 2006, 2009, and 2012. Tonsillectomy was identified using ICD-9-CM diagnosis codes 28.2 (tonsillectomy without adenoidectomy) and 28.3 (tonsillectomy with adenoidectomy). ASD was identified using ICD-9-CM diagnosis code 299 (autism). Outcomes including complications, length of hospital stay, and total hospitalization costs. Analyses were performed using multivariable models. Propensity score matching was used to control for covariate imbalance between patients with and without ASD. RESULTS: In our sample of 27,040 patients, 322 (1.2%) had a diagnosis of ASD. After controlling for potential confounders, multivariable modeling suggested patients with ASD had a shorter LOS of 0.50 days (p < 0.0001), were less likely to experience complications (odds ratio 0.57, p = 0.001), and had lower associated costs of $1308 less (p < 0.0001). Propensity score matching confirmed the findings of the multivariable modeling. CONCLUSION: Although ASD alone does not appear to confer additional costs or morbidity, differences between children with and without ASD suggest the need for providers to address patients with ASD uniquely.


Assuntos
Adenoidectomia/efeitos adversos , Transtorno do Espectro Autista/diagnóstico , Custos Hospitalares , Tempo de Internação , Tonsilectomia/efeitos adversos , Adenoidectomia/métodos , Adolescente , Transtorno do Espectro Autista/epidemiologia , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Masculino , Morbidade , Análise Multivariada , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Tonsilectomia/métodos , Resultado do Tratamento
17.
Otolaryngol Head Neck Surg ; 161(5): 734-741, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31159669

RESUMO

OBJECTIVE: To better quantify the risk of ibuprofen-associated posttonsillectomy hemorrhage (PTH). DATA SOURCES: PUBMED/MEDLINE, Web of Science, and Cochrane Clinical Trials Database. REVIEW METHOD: Literature searches were performed for English-language publications containing the terms tonsillectomy, ibuprofen, and tonsillectomy from database inception to May 2017. Human clinical trials, prospective cohort studies, and retrospective cohort studies related to tonsillectomy, ibuprofen use, and posttonsillectomy hemorrhage among pediatric patients were selected. Electronic searches revealed 151 studies, of which 12 were deemed eligible for analysis. Studies were weighted according to level of evidence and risk of bias. RESULTS: Pooling of results across all studies showed a statistically significant increase in PTH among the patients taking ibuprofen (odds ratio, 1.38; 95% confidence interval, 1.11-1.72). The I 2 statistic of 20.8% demonstrates overall low study heterogeneity and good comparability of the results. CONCLUSION: Our meta-analysis of available cohort studies and randomized controlled trials (RCTs) shows possible increased tendency to PTH with the use of ibuprofen. This has not been demonstrated in other studies and systematic reviews because their analyses were limited by use of multiple nonsteroidal anti-inflammatory drugs and inclusion of studies limited to the perioperative period and low sample size. However, the current analysis is limited due to inclusion of many retrospective cohort studies with unclear follow-up and no blinding. Further RCTs will be required to investigate this trend toward increased PTH.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Ibuprofeno/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Hemorragia Pós-Operatória/etiologia , Tonsilectomia/efeitos adversos , Humanos
18.
Int J Pediatr Otorhinolaryngol ; 124: 210-214, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31229837

RESUMO

OBJECTIVES: There is currently no standard for screening children with post-tonsillectomy bleeds (PTB) for coagulopathy disorders. This study aims to identify children with occult coagulopathy diagnosed at PTB and to identify factors associated with diagnosis. A systematic review of the literature further identified trends in this topic. METHODS: A retrospective chart review of patients returning to the operating room for PTB at a tertiary children's hospital was undertaken from 2012 to 2016. A systematic review using Medline OVID was subsequently performed. RESULTS: Of 12,503 tonsillectomies, 311 children (52% male, mean age 8 years) required surgery for PTB (2.5% rate). Twenty-one patients (7%) had multiple episodes. Only two patients (0.6%) (both with known coagulopathy) underwent pre-tonsillectomy labs and 260 (84%) had labs at PTB. Six patients (2%) were diagnosed with a new coagulopathy, most commonly von Willebrand's Disease (vWD) in five (2%). Three patients (1%) were diagnosed at first PTB and three (1%) at second PTB. Of the three diagnosed at second PTB, two had normal partial thromboplastin time (PTT). In systematic review, 1243 manuscripts were reviewed and 8 papers discussing this topic are presented. CONCLUSION: Occult coagulopathy was rarely diagnosed at PTB, but this may be limited by inconsistent screening. PT and PTT are not sensitive tests for vWD, and normal coagulation labs may lead to delayed diagnosis. The literature reveals occult coagulopathy is rare but often diagnosed after severe or recurrent hemorrhage. In order to provide efficient care and medical management, a standardized algorithm and sensitive labs for screening PTB patients are needed.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos Hemorrágicos/diagnóstico , Hemorragia Pós-Operatória/diagnóstico , Tonsilectomia/efeitos adversos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Tempo de Tromboplastina Parcial , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos
19.
Int J Pediatr Otorhinolaryngol ; 123: 84-92, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31082630

RESUMO

OBJECTIVE: The purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact on analgesic administration. METHODS: This is a prospective longitudinal study conducted with children undergoing outpatient T&A in 4 major tertiary hospitals and their parents. Children and their parents were enrolled prior to surgery and completed baseline psychological instruments assessing parental anxiety (STAI), parental coping style (MBSS), child temperament (EAS) and parental medication administration attitude questionnaire (MAQ). Postoperatively, parents and children completed at-home pain severity ratings (Faces Pain Scale-Revised, children; Numeric Rating Scale, parents) on postoperative recovery days 1, 2, and 3, reflecting an overall pain level for the past 24 h. Parents also completed a log of analgesic administration. Based on postoperative pain scores, parent-child dyads were classified as overestimators (i.e., parents rated their child's pain higher than children rated their own pain), in agreement (i.e., rating in agreement), or underestimators (i.e., parents rated their child's pain lower than children rated their own pain). RESULTS: A significant proportion of parent-child pairs disagreed on pain ratings on postoperative days 1-3 (30.05%-35.95%). Of those pairs in disagreement, the majority of parents overestimated their child's pain on all three postoperative days, specifically such that a total of 24-26% parents overestimated their child's pain on postoperative days 1, 2, and 3. Repeated measures ANOVA demonstrated that parents in the overestimator group administered higher, though still within safe limits, amounts of ibuprofen and oxycodone (mg/day) than did the underestimator or agreement groups. Multiple regression models showed hospital site as the only independent predictor for postoperative pain rating disagreement between children and parents. CONCLUSIONS: Since parents overestimate their child's postoperative pain and may administer more analgesics to their child, it is essential to develop a standardized method of child pain assessment and a tailored recommended postoperative analgesic regimen amongst medical providers for children undergoing T&A.


Assuntos
Acetaminofen/administração & dosagem , Adenoidectomia/efeitos adversos , Analgésicos/administração & dosagem , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Pais , Tonsilectomia/efeitos adversos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino , Dor Pós-Operatória/etiologia , Pais/psicologia , Estudos Prospectivos , Inquéritos e Questionários
20.
J Nepal Health Res Counc ; 17(1): 71-75, 2019 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-31110380

RESUMO

BACKGROUND: Intraoperative bleeding and postoperative pain are two commonest concerns for both patient and surgeon in tonsillectomy. This study was aimed to compare intraoperative blood loss and early postoperative pain between ultrasonic device and bipolar diathermy tonsillectomy in children. METHODS: Prospective, interventional, single blinded, comparative study was carried out from September 2016 to September 2017 including children up to age 15 years who underwent tonsillectomy either by bipolar diathermy or ultrasonic device. Intraoperative blood loss was recorded using standard sized gauge technique. Post-tonsillectomy pain on first five postoperative days (early postoperative pain) was assessed using Visual analog scale for children older than 5 years and FLACC score for children up to 5 years respectively.Means were compared. RESULTS: 38 children (76 tonsils) were included in the study out of which 31 were boys (62 tonsils) and 7 were girls (14 tonsils). The mean intraoperative blood loss in ultrasonic dissection group was 13.94 ml and 13.91 ml in bipolar diathermy group. This difference was not statistically significant (p=0.974). Post-operative pain on 1st, 2nd, 3rd and 4th days were significantly less (p<0.05) in ultrasonic device group compared to bipolar diathermy group. Post-operative pain was less also on 5th post-operative day in ultrasonic device but was not statistically significant (p=0.172). CONCLUSIONS: Tonsillectomy in children using ultrasonic device did not differ from bipolar diathermy tonsillectomy in respect to intraoperative blood loss. However, early postoperative pain was significantly lower in ultrasonic device group.


Assuntos
Eletrocoagulação/métodos , Tonsilectomia/métodos , Procedimentos Cirúrgicos Ultrassônicos/métodos , Adolescente , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Criança , Pré-Escolar , Eletrocoagulação/efeitos adversos , Feminino , Humanos , Masculino , Medição da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Método Simples-Cego , Tonsilectomia/efeitos adversos , Procedimentos Cirúrgicos Ultrassônicos/efeitos adversos
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