Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
-
Otolaryngol Head Neck Surg · Aug 2011
Multicenter Study Comparative Study Clinical TrialAdenoidectomy technique in the United Kingdom and postoperative hemorrhage.
To investigate the incidence of postoperative hemorrhage and its risk factors after adenotonsillectomy. ⋯ Use of suction diathermy in adenoidectomy appears to have a similar safety profile to conventional techniques and may offer additional benefits over traditional adenoid curettage. Further clinical and laboratory-based research into the complex interaction between diathermy usage and both adenoid and tonsillar tissue is warranted.
-
Otolaryngol Head Neck Surg · Jul 2011
Practice GuidelineClinical practice guideline: Polysomnography for sleep-disordered breathing prior to tonsillectomy in children.
This guideline provides otolaryngologists with evidence-based recommendations for using polysomnography in assessing children, aged 2 to 18 years, with sleep-disordered breathing and are candidates for tonsillectomy, with or without adenoidectomy. Polysomnography is the electrographic recording of simultaneous physiologic variables during sleep and is currently considered the gold standard for objectively assessing sleep disorders. ⋯ The committee made the following recommendations: (1) before determining the need for tonsillectomy, the clinician should refer children with sleep-disordered breathing for polysomnography if they exhibit certain complex medical conditions such as obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders, sickle cell disease, or mucopolysaccharidoses. (2) The clinician should advocate for polysomnography prior to tonsillectomy for sleep-disordered breathing in children without any of the comorbidities listed in statement 1 for whom the need for surgery is uncertain or when there is discordance between tonsillar size on physical examination and the reported severity of sleep-disordered breathing. (3) Clinicians should communicate polysomnography results to the anesthesiologist prior to the induction of anesthesia for tonsillectomy in a child with sleep-disordered breathing. (4) Clinicians should admit children with obstructive sleep apnea documented on polysomnography for inpatient, overnight monitoring after tonsillectomy if they are younger than age 3 or have severe obstructive sleep apnea (apnea-hypopnea index of 10 or more obstructive events/hour, oxygen saturation nadir less than 80%, or both). (5) In children for whom polysomnography is indicated to assess sleep-disordered breathing prior to tonsillectomy, clinicians should obtain laboratory-based polysomnography, when available.
-
Otolaryngol Head Neck Surg · Jul 2011
Psychomotor skills training in pediatric airway endoscopy simulation.
To develop a robust psychomotor skills curriculum to teach pediatric airway foreign body retrieval and to assess the effect of this curriculum on residents' confidence in and ability to perform the complete task in an infant airway mannequin. ⋯ Simulation-based subtask training shows promise as an effective and reproducible method to teach the complex psychomotor task of airway foreign body retrieval. Completion of the curriculum led to a significant improvement in residents' confidence in and ability to perform bronchoscopic foreign body retrieval in an infant airway mannequin.
-
Otolaryngol Head Neck Surg · Jul 2011
Using medical simulation to teach crisis resource management and decision-making skills to otolaryngology housestaff.
Develop a course to use in situ high-fidelity medical simulation (HFS) in an actual operating room (OR) to (1) teach teamwork and crisis resource management (CRM) skills simultaneously to otolaryngology and anesthesia trainees and OR nurses and (2) provide decision-making experience to ear, nose, and throat residents and OR teams in simulated high-risk, low-frequency airway emergencies. ⋯ Using a newly developed, in situ HFS-based course, clinical decision-making skills and teamwork can be effectively taught concurrently to members of an OR team.
-
Otolaryngol Head Neck Surg · Jun 2011
Review Meta AnalysisDexamethasone and tonsillectomy bleeding: a meta-analysis.
To use meta-analytic techniques to examine the effect of dexamethasone on the risk of postoperative bleeding following tonsillectomy. ⋯ The results of this meta-analysis indicate that perioperative dexamethasone does not confer an increased risk of postoperative bleeding in patients undergoing tonsillectomy.