International journal of pediatric otorhinolaryngology
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Int. J. Pediatr. Otorhinolaryngol. · May 2013
Discharge after tonsillectomy in pediatric sleep apnea patients.
Outpatient tonsillectomy has gained favor in recent years, however patients with obstructive sleep apnea/hypopnea syndrome have been excluded from outpatient surgery criteria. It is the practice of the senior author to discharge patients after tonsillectomy with a respiratory disturbance or apnea hypopnea index of 5 or less. The purpose of this study is to examine the respiratory complication rate based on respiratory disturbance or apnea hypopnea index, and co-morbidities in order to determine which pediatric patients with obstructive sleep apnea/hypopnea syndrome can be safely discharged after tonsillectomy. ⋯ Our data suggest there is a correlation between higher respiratory disturbance or apnea hypopnea index and post operative complications. Patients with an RDI of <5.0, and minimal co-morbidities can be safely discharged home following tonsillectomy for OSAHS. Complications related to sleep apnea were not seen in patients with RDI <11.0, suggesting that patients with an RDI between 5 and 10, who are not obese and have no significant comorbidities may also be sent home after surgery.
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Int. J. Pediatr. Otorhinolaryngol. · May 2013
The dysphonic videolaryngoscopy with stroboscopy paradox and challenge of acquired subglottic stenosis after laryngotracheal reconstruction.
There's no greater challenge in pediatric laryngology than diagnosis and treatment of chronic dysphonia following laryngotracheal reconstruction of acquired subglottic stenosis. Videolaryngoscopy with stroboscopy provides incomparable diagnostic information to fiberoptic endoscopy. Unfortunately, this pediatric subpopulation which would benefit the most from videolaryngoscopy with stroboscopy infrequently does. We present the unique videolaryngostroboscopic patterns with their diagnostic and treatment implications in this complex population. ⋯ Videolaryngoscopy with stroboscopy results in patterns that are not only unique to patients after airway reconstruction for subglottic stenosis but are also critical for both surgical and non-surgical treatment of chronic dysphonia in these children.
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Int. J. Pediatr. Otorhinolaryngol. · May 2013
Case ReportsDeath after adenotonsillectomy secondary to massive pulmonary embolism.
Tonsillectomy is one of the most common surgical procedures performed in the United States. Although relatively safe, there is a small risk of post-operative mortality. The majority of deaths come from airway compromise or hemorrhage. ⋯ The cause of death determined by post mortem autopsy was massive pulmonary embolism (PE). PE is a rare event in children and has never been reported as the cause of death following adenotonsillectomy in a child. This case is reviewed in addition to recent literature regarding obstructive sleep apnea (OSA) as a risk factor for venous thrombosis and PE.
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93% of patients at a GP practice in Surrey were given antibiotics for acute otitis media over a year. Only 52% of these antibiotics were given according to the NICE guideline criteria, offering massive scope for a more rationalised approach to antibiotic prescribing. Given the huge importance of controlling antibiotic resistance and the large incidence of acute otitis media, any reforms could potentially massively reduce unnecessary antibiotic prescriptions in the community.
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Int. J. Pediatr. Otorhinolaryngol. · May 2013
Proper size of endotracheal tube for cleft lip and palate patients and intubation outcomes.
The aim of the current study was to identify the proper size of endotracheal tube for intubation of cleft lip and palate patients and intubation outcomes in these patients. ⋯ Findings proved that considering subglottic stenosis incidence in these children, it is reasonable to determine the tube size for nonsyndromic cleft lip and palate patients by applying the currently available standards for normal children.