International journal of pediatric otorhinolaryngology
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Int. J. Pediatr. Otorhinolaryngol. · May 2017
Observational StudyAssociation of sleep disordered breathing symptoms with early postoperative analgesic requirement in pediatric ambulatory surgical patients.
Sleep disordered breathing (SDB) symptoms are associated with increased rates of opioid-induced respiratory depression as well as enhanced nociception. Consequently, practitioners often withhold or administer lower intraoperative doses of opioids out of concern for postoperative respiratory depression. Therefore, SDB may be a critical determinant of analgesic requirement in the post-anesthesia care unit (PACU). We investigated whether preoperative SDB classification was independently associated with need for PACU analgesic intervention in a cross-sectional sample of 985 children who underwent elective, painful ambulatory surgical procedures. ⋯ These results suggest that preoperative SDB symptoms in children undergoing ambulatory surgery, exerts a significant influence on PACU pain behavior and analgesic requirement. Mechanisms underlying this enhanced pain experience deserve further elucidation.
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Int. J. Pediatr. Otorhinolaryngol. · May 2017
The public health resource utilization impact of airway foreign bodies in children.
Quantify the resource utilization associated with airway foreign bodies in children in the United States using a national database and report observed trends over time. ⋯ The public health and economic burden of pediatric airway foreign bodies appears to be rising. Further investigation may be helpful to examine factors that may be contributing to increasing charges and creating strategies to improve cost effectiveness, as well as why there seems to be increased resource utilization in urban locations and teaching hospitals.
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Int. J. Pediatr. Otorhinolaryngol. · May 2017
Peri-operative management of high-risk paediatric adenotonsillectomy patients: A survey of 35 UK tertiary referral centres.
Peri-operative management of high-risk paediatric patients undergoing adenotonsillectomy for treatment of obstructive sleep apnoea varies between tertiary referral hospitals. 'Day of surgery cancellation' (DoSC) rates of up to 11% have been reported due to pre-booked critical care being unavailable on the day of surgery as a result of competing needs from other hospital departments. We report the results of a survey of peri-operative management in UK tertiary care centres of high-risk paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea (OSA). ⋯ In the context of limited critical care resources, variation in practice and difficulty in accurately predicting which patients will require post-operative critical care beds, a review and consensus on best practice in the peri-operative management of high risk paediatric adenotonsillectomy patients may offer a safe means of reducing cancellations and improving patient care, resource allocation and hospital efficiency.
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Int. J. Pediatr. Otorhinolaryngol. · May 2017
Case ReportsTracheal tear from blunt neck trauma in children: Diagnosis and management.
We describe the management of posterior trachea tears after blunt neck trauma in two children. The first, a 5 year-old boy who fell off his scooter, causing a 1.0cm tear in the membranous cervical trachea, was managed conservatively with 5 days of intubation. ⋯ The presumed mechanism may be expansion of the U-shaped cartilage with tear of the membranous trachea. The size, location, and severity of symptoms dictate the decision about primary repair versus conservative management.