International journal of pediatric otorhinolaryngology
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The prevalence of obesity in the pediatric population has risen more than 20% in 25 years. Accordingly, surgical procedures on obese children have become more common. Adenotonsillectomy (AT) remains among the most frequently performed pediatric surgical procedures in the United States. Our objective was to determine if there is an increased complication rate in morbidly obese (MO) children undergoing AT and if elective pediatric intensive care unit (PICU) admission for observation is warranted. ⋯ Our study concluded that routine PICU admission was not warranted for most MO patients although several required supplemental oxygen, BiPAP, and one required intubation. These interventions can easily be administered in a surgical floor bed. In fact, these results imply that performing this surgical procedure in obese children is not as risky as many believe. Trends were noted for an increased need of airway interventions in children requiring preoperative BiPAP and in those with comorbidities. In this small population, sample AT was performed on the basis of history. This is to serve as a pilot review for a prospective study in which preoperative PSGs would be used to determine potential indicators for elective PICU admission.
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Int. J. Pediatr. Otorhinolaryngol. · Apr 2003
Analysis of the causes of immediate unanticipated bleeding after pediatric adenotonsillectomy.
To assess the incidence of unexpected postoperative bleeding in children undergoing adenoidectomy and/or tonsillectomy (T&A), and to investigate its possible undetected haematological causes. ⋯ The incidence of bleeding after adeno and/or tonsillectomy at our institution is comparable with series previously reported in the current medical literature. In nearly one half of the cases, undetected coagulation diseases (mainly von Willebrand's disease) are diagnosed after surgery in the haematological study.
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Int. J. Pediatr. Otorhinolaryngol. · Apr 2003
Paediatric acute epiglottitis: not a disappearing entity.
Paediatric epiglottitis is a serious, potentially life-threatening condition. Since the widespread introduction of the Haemophilus influenzae type b (Hib) conjugate vaccine in the UK in October 1992, there has been a dramatic reduction in its incidence. Vaccine failure is rare. The purpose of this study is to examine the failure rate of H. influenzae type b vaccine as measured by the number of cases of Haemophilus epiglottitis in fully vaccinated children presenting to a tertiary paediatric centre. A secondary aim is to provide a retrospective review of all cases of epiglottitis over a 13-year period. ⋯ Whilst the incidence of Haemophilus type b epiglottitis has significantly diminished, vaccine failure does occur. We discuss the current understanding of clinical and immunological risk factors for vaccine failure and the significance of the Hib antibody titre. Further evaluation of vaccine failure would be of benefit. The series that we present highlights the importance of considering acute epiglottitis in the differential diagnosis of the child presenting with acute upper airway obstruction. This is particularly relevant when in future there will be fewer doctors familiar with the symptoms and signs of the disease.