RESUMEN
In randomized controlled trials, adjusting for baseline covariates is commonly used to improve the precision of treatment effect estimation. However, covariates often have missing values. Recently, Zhao and Ding studied two simple strategies, the single imputation method and missingness-indicator method (MIM), to handle missing covariates and showed that both methods can provide an efficiency gain compared to not adjusting for covariates. To better understand and compare these two strategies, we propose and investigate a novel theoretical imputation framework termed cross-world imputation (CWI). This framework includes both single imputation and MIM as special cases, facilitating the comparison of their efficiency. Through the lens of CWI, we show that MIM implicitly searches for the optimal CWI values and thus achieves optimal efficiency. We also derive conditions under which the single imputation method, by searching for the optimal single imputation values, can achieve the same efficiency as the MIM. We illustrate our findings through simulation studies and a real data analysis based on the Childhood Adenotonsillectomy Trial. We conclude by discussing the practical implications of our findings.
Asunto(s)
Simulación por Computador , Modelos Estadísticos , Ensayos Clínicos Controlados Aleatorios como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Humanos , Interpretación Estadística de Datos , Niño , Biometría/métodos , Adenoidectomía/estadística & datos numéricos , Tonsilectomía/estadística & datos numéricosRESUMEN
Objective: Ciprofol is a novel anesthetic agent, its efficacy and safety had been verified and its clinical implementation has been expanded. However, the knowledge about ciprofol in children is meager. The aim of study is to evaluate the safety and effectiveness of ciprofol in general anesthesia in children undergoing adenoidectomy and adenotonsillectomy, compared with propofol. Materials: We retrospectively analyzed data of children who underwent adenoidectomy or adenotonsillectomy with general anesthesia from June to August 2023 to evaluate the safety and effectiveness of ciprofol. The primary outcomes included hemodynamic changes during induction and postoperative complications in post-anesthesia care unit. The secondary outcomes were extubation time, pediatric anesthesia emergence delirium (PAED) score. Meanwhile, subgroup analysis was performed based on age. Results: 301 children met the inclusion criteria, 157 received ciprofol induction and 144 received propofol. Patient demographics and operation-related information were similar in the two groups. However, the dosage of dexmedetomidine in the propofol group was significantly higher than that of the ciprofol group (p=0.001). The trends of hemodynamic shift during induction and intubation were the same in the two groups. The PAED scores on post-extubation 10min and 20min were significantly reduced in the ciprofol group (p<0.001 and p=0.046). Moreover, in the ≤72 months and the >72 months subgroups, the scores were also significantly lower in the ciprofol group on post-extubation 10min. With the score of >10, the incidence of emergence delirium of the ciprofol group was significantly lower on post-extubation 10min and 20min in the population and the ≤72 months subgroups (p=0.03 and p=0.02). There were no obvious postoperative complications in both groups. Conclusion: Ciprofol exhibited advantageous characteristics in the induction of children, such as stable hemodynamics, a relatively lower incidence of postoperative delirium without apparent post-anesthesia complications. Ciprofol may emerge as a novel option for general anesthesia in pediatric patients.
Asunto(s)
Adenoidectomía , Anestesia General , Tonsilectomía , Humanos , Estudios Retrospectivos , Masculino , Femenino , Preescolar , Niño , Adenoidectomía/efectos adversos , Anestesia General/efectos adversos , Tonsilectomía/efectos adversos , Propofol/administración & dosificación , Propofol/efectos adversos , Complicaciones Posoperatorias , Lactante , Estudios de CohortesRESUMEN
INTRODUCTION: The adenoids and palatine tonsils, part of the lymphoid tissue, act as a first line of defense protecting the lower airways and gastrointestinal tract. Adenotonsillar hypertrophy in children may lead to airway obstruction. This study aims to demonstrate the association between adenotonsillar hypertrophy and decreased blood oxygen saturation. METHODS: A retrospective cohort study was conducted among children aged 7-12 years with adenotonsillar hypertrophy and obstructive symptoms, admitted to King Fahad Hospital and Prince Mishari Hospital, Saudi Arabia, for tonsillectomy between July 2023 and January 2024. Exclusion criteria included respiratory diseases, cardiac disease, nasal polyps, nasal septum deviation, chest wall abnormality, and lower airway diseases. The control group included 56 healthy children. An otolaryngologist determined the severity of airway obstruction using the tonsil size. Oxygen saturation was measured using pulse oximetry. The determinants of oxygen saturation were assessed using multiple linear regression, with significance set at p<0.05. RESULTS: The study included 357 participants, with an even age distribution between 7-9 years (49.6%) and 10-12 years (50.4%), and 52% males. Diagnoses included adenoid hypertrophy (30%), tonsil hypertrophy (35%), both conditions (19%), and the control group (16%). Tonsil sizes ranged from Grade 1 (48%) to Grade 4 (8.4%), with 17% normal. The median oxygen saturation was 96.0% for the adenotonsillar hypertrophy group and 99.0% for the control. Oxygen saturation levels differed significantly across groups (p<0.0001), with lower median saturation in hypertrophy groups than controls. Males had a lower oxygen than females (estimate: -0.338, 95% CI [--0.640, -0.036], p=0.028). Adenoid hypertrophy (estimate: -3.863, 95% CI [-5.241, -2.484], p<0.001), tonsil hypertrophy (estimate: -3.631, 95% CI [-5.053, -2.208], p<0.001) and having both conditions (estimate: -3.777, 95% CI [-5.3.7, -2.247], p<0.001) was associated with lower oxygen saturation. Grade 1 tonsil size was associated with an increase in oxygen saturation (estimate = 2.905, 95% CI [1.616, 4.194], p<0.001). In contrast, Grade 4 tonsil size was linked to lower oxygen saturation (estimate=-4.848, 95% CI [-6.367, -3.329], p<0.001). Grades 2 and 3 were not significantly associated with changes in oxygen saturation. CONCLUSION: Adenotonsillar hypertrophy is significantly associated with decreased blood oxygen saturation and related cardiopulmonary complications in children. Early adenotonsillectomy may be of benefit in preventing these complications and improving oxygen saturation levels.
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Tonsila Faríngea , Hipertrofia , Saturación de Oxígeno , Tonsila Palatina , Humanos , Tonsila Faríngea/patología , Niño , Masculino , Femenino , Arabia Saudita , Tonsila Palatina/patología , Estudios Retrospectivos , Saturación de Oxígeno/fisiología , Tonsilectomía , Obstrucción de las Vías Aéreas/sangre , Obstrucción de las Vías Aéreas/patología , OximetríaRESUMEN
The dose-response of intravenous lidocaine in preventing postoperative vomiting (POV) in children remains unclear. This study investigated whether intravenous lidocaine dose-dependently decreased POV risk within 24 h postoperatively in children undergoing tonsillectomy (with or without adenoidectomy) without severe complications. Patients aged 3-12 years (American Society of Anesthesiologists grade I-II) scheduled for elective tonsillectomy (with or without adenoidectomy) were enroled from December 2021 to March 2022. They were randomly grouped according to the lidocaine dose (A [0 mg kg-1], B [1 mg kg-1], C [1.5 mg kg-1], and D [2 mg kg-1]) and were administered the same induction protocol (sufentanil, propofol, and suxamethonium chloride). Anaesthesia was maintained with sevoflurane. The incidence of POV within 24 h postoperatively was 46, 40, 36, and 20% in groups A, B, C, and D, respectively, with significant differences between groups D and A. Postoperative analgesic rescues in groups A, B, C, and D were 62, 36, 34, and 16%, respectively, with significant differences between groups D and B, C and A, and D and A. No severe adverse events were reported. Intravenous lidocaine has a dose-dependent effect on reducing the risk of POV in children undergoing tonsillectomy (with or without adenoidectomy) without serious adverse events.Trial registration: Chinese Clinical Trial Registry, ChiCTR2100053006.
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Lidocaína , Náusea y Vómito Posoperatorios , Tonsilectomía , Humanos , Tonsilectomía/efectos adversos , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Lidocaína/efectos adversos , Niño , Masculino , Preescolar , Femenino , Náusea y Vómito Posoperatorios/prevención & control , Adenoidectomía/efectos adversos , Relación Dosis-Respuesta a Droga , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéuticoRESUMEN
BACKGROUND: In the emergency department (ED), there are pre-assembled tonsillar hemorrhage trays for management of post-tonsillectomy hemorrhage and peritonsillar abscess. After use, the tray is sent to the medical device reprocessing (MDR) department for decontamination, sterilization, and re-organization, all at a significant cost to the hospital and environment. OBJECTIVE: The goal of this project was to reduce unnecessary instruments on the tonsil hemorrhage tray by 30% by 1 year and report on the associated cost and carbon dioxide (CO2) emissions savings. METHODS: This quality improvement project was framed according to the Institute for Healthcare Improvement's Model for Improvement. ED and Otolaryngology-Head & Neck Surgery staff and residents were surveyed to determine which instruments on the tonsil hemorrhage trays were used regularly. Based on results, a new tray was developed and compared to the old tray using MDR data and existing CO2 emissions calculations. RESULTS: Tray optimization resulted in a total cost reduction from $1092.63 to $330.21 per tray per year, decreased processing time from 12 to 6-8 minutes per tray, and decreased CO2 emissions from 6.11 to 2.85 kg per year for the old versus new tray, respectively. Overall, the new tray contains half the number of instruments, takes half the time to assemble, produces 50% less CO2 emissions, and will save the hospital approximately $100,000 over 10 years. CONCLUSION: Healthcare costs and environmental sustainability are collective responsibilities. Surgical and procedure tray optimization is a simple, effective, and scalable form of eco-action.
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Mejoramiento de la Calidad , Instrumentos Quirúrgicos , Centros de Atención Terciaria , Tonsilectomía , Humanos , Instrumentos Quirúrgicos/economía , Hemorragia Posoperatoria/terapia , Canadá , Servicio de Urgencia en Hospital , Absceso Peritonsilar/terapiaRESUMEN
OBJECTIVE: To investigate regional disparities in the length of hospital stay (LOS) for pediatric patients undergoing tonsillectomy for obstructive sleep apnea (OSA) in the United States. METHODS: We utilized the Healthcare Cost and Utilization Project (HCUP) Kid Inpatient Database (KID) for 2016, analyzing data on pediatric OSA patients aged 0-20. We compared LOS in different U.S. regions and employed statistical tests to assess significance. RESULTS: Regional variation in LOS was observed among pediatric OSA patients. The Midwest and South regions showed longer LOS compared to the West and Northeast. Notably, standard deviations for LOS in the Midwest and South were substantial, signifying significant variability. CONCLUSION: Our findings emphasize the importance of addressing regional differences in pediatric OSA care. Prolonged hospital stays can impose significant burdens on children and families. Identifying and mitigating factors driving these disparities is crucial for enhancing the quality and efficiency of care, ultimately striving for more equitable healthcare for pediatric OSA patients nationwide.
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Tiempo de Internación , Apnea Obstructiva del Sueño , Tonsilectomía , Humanos , Apnea Obstructiva del Sueño/cirugía , Niño , Masculino , Tiempo de Internación/estadística & datos numéricos , Femenino , Preescolar , Estados Unidos , Adolescente , Tonsilectomía/estadística & datos numéricos , Lactante , Bases de Datos Factuales , Adulto Joven , Recién Nacido , Disparidades en Atención de Salud/estadística & datos numéricosRESUMEN
OBJECTIVES: To assess the safety and effectiveness of perioperative ibuprofen in pediatric tonsillectomy through a meta-analysis of relevant randomized controlled trials. METHODS: We conducted a comprehensive review of studies available in PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to June 2024. This analysis compared perioperative ibuprofen administration to control groups (saline, acetaminophen, or opioids). Outcomes assessed were postoperative pain management, as indicated by the frequency of analgesic use, and morbidity rates, which included the incidence of postoperative nausea and vomiting and post-tonsillectomy hemorrhage (PTH). PTH was further categorized as primary (occurring on the day of operation) or secondary (occurring after the day of operation), and classified as type 1 (observed at home or evaluated in the emergency department without further intervention), type 2 (requiring readmission for observation), or type 3 (necessitating a return to the operating room for hemorrhage control). RESULTS: This analysis included nine studies involving a total of 1545 patients. Incidences of primary PTH (OR = 1.0949, 95 % CI [0.4169; 2.8755], I2 = 0.0 %), secondary PTH (OR = 1.6433 95 % CI [0.7783; 3.4695], I2 = 0.1 %), and overall PTH (OR = 1.4296 95 % CI [0.8383; 2.4378], I2 = 0.0 %) were not significantly higher in the ibuprofen group than the control groups. Administration of ibuprofen led to a significant decrease in postoperative nausea and vomiting (OR = 0.4228 95 % CI [0.2500; 0.7150], I2 = 40.0 %) and frequency of postoperative analgesic uptake (OR = 0.4734 95 % CI [0.2840; 0.7893]; I2 = 19.8 %). There was no difference in bleeding by type between the ibuprofen and control groups. CONCLUSIONS: Our meta-analysis demonstrated that administration of ibuprofen for pediatric tonsillectomy did not significantly increase the incidence of postoperative bleeding but did decrease postoperative emesis and improve pain control.
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Ibuprofeno , Dolor Postoperatorio , Tonsilectomía , Humanos , Tonsilectomía/efectos adversos , Ibuprofeno/uso terapéutico , Ibuprofeno/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Niño , Analgésicos no Narcóticos/uso terapéutico , Analgésicos no Narcóticos/administración & dosificación , Atención Perioperativa/métodos , Manejo del Dolor/métodos , Ensayos Clínicos Controlados Aleatorios como AsuntoAsunto(s)
Tonsilitis , Humanos , Tonsilitis/diagnóstico , Diagnóstico Diferencial , Masculino , Tonsilectomía , Femenino , Tonsila Palatina/patologíaRESUMEN
BACKGROUND: Postoperative sore throat is one of the main postoperative complaints in patients undergoing tonsillectomy. As the primary outcome, we aimed to determine whether endotracheal tube cuffs filled with alkalinized lidocaine are associated with a lower incidence of postoperative sore throat and anesthesia emergence phenomena in children undergoing tonsillectomy or adenotonsillectomy. We also assessed the potential additional benefits of IV dexamethasone in reducing postoperative laryngotracheal morbidity. METHODS: This is a clinical prospective, randomized, controlled trial. Patients were randomly allocated to one of four groups, as follows: air - endotracheal tube cuff filled with air; air/dex - endotracheal tube cuff filled with air and intravenous dexamethasone; lido - endotracheal tube cuff filled with alkalinized lidocaine; and lido/dex - endotracheal tube cuff filled with alkalinized lidocaine and intravenous dexamethasone. Perioperative hemodynamic parameters and the incidence of postoperative nausea and vomiting, coughing and hoarseness were recorded. Postoperative sore throat was assessed in the postanesthetic care unit and 24 hours post tracheal extubation. RESULTS: In total, 154 children aged 4-12 years, ASA physical status I or II, undergoing general anesthesia for elective tonsillectomy and adenotonsillectomy, were assessed for postoperative sore throat in this study. The incidence of postoperative sore throat 24 hours after tracheal extubation was significantly lower in the lido/dex group compared to groups air and air/dex (p = 0.01). However, no additional reduction in these symptoms was observed from the intravenous administration of dexamethasone when comparing the lido and lido/dex groups. Similarly, there were no differences among groups regarding perioperative hemodynamic variables or postoperative nausea and vomiting, coughing, and hoarseness during the study period. CONCLUSION: Intracuff alkalinized lidocaine, associated with intravenous dexamethasone, might be effective in reducing sore throat 24 hours post-tonsillectomy or adenotonsillectomy in children when compared to the use of air as the cuff insufflation media.
Asunto(s)
Anestesia General , Anestésicos Locales , Dexametasona , Intubación Intratraqueal , Lidocaína , Faringitis , Complicaciones Posoperatorias , Tonsilectomía , Humanos , Dexametasona/administración & dosificación , Tonsilectomía/métodos , Tonsilectomía/efectos adversos , Lidocaína/administración & dosificación , Niño , Masculino , Preescolar , Femenino , Anestesia General/métodos , Faringitis/prevención & control , Faringitis/etiología , Faringitis/epidemiología , Estudios Prospectivos , Intubación Intratraqueal/métodos , Intubación Intratraqueal/efectos adversos , Anestésicos Locales/administración & dosificación , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Administración Intravenosa , Náusea y Vómito Posoperatorios/epidemiología , Náusea y Vómito Posoperatorios/prevención & controlRESUMEN
OBJECTIVE: To determine if perioperative administration of dexmedetomidine affects postoperative fluid intake in tonsillectomy patients. METHODS: A retrospective chart review was performed at University Medical Center, Texas Tech Health Science Center, Lubbock, Texas. The study identified 534 patients within the last five years who met the criteria. Common indications for the surgeries included recurrent tonsillitis, obstructive sleep apnea, and sleep disordered breathing. Patients with concurrent peritonsillar abscess drainage, microlaryngoscopy, bronchoscopy, supraglottoplasty, and other procedures that may impact fluid intake were excluded. The relationship between dexmedetomidine and fluid intake was evaluated using bivariate analysis as well as multivariable regression to account for possible confounders such as age, concurrent medication, surgery type, and method of surgery using STATA statistical software, version 17.0 (StataCorp LLC, College Station, TX). RESULTS: Administration of dexmedetomidine did not significantly impact the amount of fluid intake, fluid intake per kilogram per hour, or average postoperative pain levels in patients who underwent tonsillectomy or adenotonsillectomy in the bivariate analysis (p = 0.217, 0.489, 0.512 respectively) and multiple regression model (p = 0.156, 0.802, 0.795) CONCLUSION: Dexmedetomidine does not negatively influence postoperative fluid intake levels in patients and should continue to be utilized in appropriately selected patients experiencing anxiety or agitation prior to surgery.
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Adenoidectomía , Deshidratación , Dexmedetomidina , Dolor Postoperatorio , Tonsilectomía , Humanos , Dexmedetomidina/administración & dosificación , Dexmedetomidina/uso terapéutico , Masculino , Femenino , Estudios Retrospectivos , Niño , Dolor Postoperatorio/tratamiento farmacológico , Preescolar , Adolescente , Adulto , Ingestión de Líquidos , Apnea Obstructiva del Sueño/cirugía , Adulto Joven , Tonsilitis/cirugía , Persona de Mediana Edad , Hipnóticos y Sedantes/uso terapéutico , Hipnóticos y Sedantes/administración & dosificación , Síndromes de la Apnea del SueñoRESUMEN
Objective:To investigate the long-term effect of partial tonsillectomy in children with tonsil hypertrophy. Methods:A total of 146 children with obstructive sleep apneaï¼OSAï¼ who received surgical treatment for tonsil hyperplasia from January 2010 to January 2013 were selected and divided into the observation groupï¼n=69ï¼ and the control groupï¼n=77ï¼. The observation group was received tonsillotomyï¼TTï¼, and the control group was received total tonsillectomyï¼TEï¼. Parental satisfaction and OSA quality of life questionnaire for childrenï¼OSA-18ï¼ were surveyed. Residual tonsil size was measured, and polysomnographyï¼PSGï¼ was monitored after 10 years. HE and immunohistochemical analysis were performed on tonsil tissues of one patient who performed a second operation after TT in 2017 year. Results:The results of questionnaire survey showed that the symptoms of respiratory obstruction were significantly improved in both groups, and the satisfaction of TT group was higher than that in the TE group. No increase in the number of respiratory tract infections was observed in all patients. In the TT group, nine casesï¼13.04%ï¼ had tonsil hyperplasia toâ ¡°, and the remaining patients had tonsil hyperplasia to â °. In addition, one case hadtonsil suppurative infection at the 14th month after surgery, and no recurrence or reoperation was found after treatment. There were seven cases in the TT group and eight cases in the TE group with occasional snoring and mouth breathing after surgery, but the PSG examination of the patients did not meet the diagnosis of OSA. The main causes were obesity and allergic rhinitis. Compared with the first operation, the cicatricial obstruction and infection of tonsil tissue in the second operation were not significantly changed, and the immunohistochemical results also demonstrated that the expression of CD20 was not changed, and the expression of CD3 was decreased. Conclusion:Both TT and TE can effectively improve the symptoms of OSA obstruction in children. TT has less trauma, less postoperative pain, faster recovery and lower rate of hyperplasia, which can be used as one of the main methods for the treatment of tonsil hypertrophy in children.
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Hiperplasia , Hipertrofia , Tonsila Palatina , Apnea Obstructiva del Sueño , Tonsilectomía , Humanos , Tonsilectomía/métodos , Apnea Obstructiva del Sueño/cirugía , Niño , Masculino , Femenino , Hiperplasia/cirugía , Tonsila Palatina/cirugía , Tonsila Palatina/patología , Hipertrofia/cirugía , Resultado del Tratamiento , Calidad de Vida , Encuestas y Cuestionarios , Polisomnografía , Preescolar , Satisfacción del Paciente , ReoperaciónRESUMEN
Tonsillectomy is one of the most frequent surgical interventions in otorhinolaryngology. This surgical is always accompanied by the development of reactive inflammatory phenomena and pain syndrome. The effectiveness and safety of tonsillectomy can be improved through the use of topical treatment in the postoperative period, including antiseptics in the form of a spray. An observational study was conducted at the Department of Otorhinolaryngology of the Russian University of Medicine of the Ministry of Health of the Russian Federation, the purpose of which was to evaluate the clinical efficacy, tolerability and safety of Viroxynol for oral and throat mucosa in patients after tonsillectomy. As a result of the analysis of the data obtained, it was found that the use of Viroxynol for the mucous membrane of the oral cavity and throat in the treatment of patients in the early postoperative period causes a pronounced clinical effect, reduces the need for additional medications, allows faster reduction of pain syndrome against the background of relief of reactive inflammatory phenomena, improves the quality of life of patients, accelerates the healing process, reduces the risk of bacterial inflammation. The drug may be recommended for use in patients after tonsillectomy.
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Dolor Postoperatorio , Tonsilectomía , Humanos , Tonsilectomía/métodos , Tonsilectomía/efectos adversos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Masculino , Femenino , Adulto , Resultado del Tratamiento , Periodo Posoperatorio , Antiinfecciosos Locales/administración & dosificaciónRESUMEN
AIM: To evaluate the efficacy of immunosuppressive therapy (IST) and tonsillectomy (TE) in patients with high-risk IgA nephropathy (IgAN). Materials and мethods. The retrospective study cohort included cases with primary IgAN (n=213, age 34±11 years, male 52%) at high risk of progression with clinical and morphological data collected. The follow-up was 26 (10; 61) months. The association of IST without TE (IST; n=141) or with TE (IST+TE; n=72) with the development of complete (PR), partial (PR) and overall (PR or PR, OR) remissions was investigated. RESULTS: The incidence of achieving early PR or OR in the IST and IST+TE groups was 65.2% and 86.1%, respectively (p=0.002). The probability of early PR or OR was significantly increased in the IST+TE group compared to IST [HR 1.714 (1.214-2.420) and HR 3.410 (1.309-8.880), respectively]. IST+TE was associated with a 3- to 4-fold increase in the likelihood of PR or OR at the end of follow-up [HR 2.575 (1.679-3.950) and HR 4.768 (2.434-9.337), respectively]. Analyses using pseudorandomisation methods yielded similar results. CONCLUSION: TE may be effective for remission induction in high-risk IgAN.
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Glomerulonefritis por IGA , Tonsilectomía , Humanos , Glomerulonefritis por IGA/cirugía , Glomerulonefritis por IGA/tratamiento farmacológico , Tonsilectomía/métodos , Masculino , Adulto , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Inmunosupresores/administración & dosificación , Inducción de Remisión/métodos , Terapia de Inmunosupresión/métodosRESUMEN
BACKGROUND: The most important problem in tonsillectomy is pain in the early postoperative period. OBJECTIVE: We purposed to compare the effects of lidocaine, tetracaine, and articaine application to the peritonsillar bed on post-tonsillectomy pain in children. METHODS: The prospective, placebo-controlled study included 80 patients, ages 3-14, who were scheduled for elective tonsillectomy. Patients were randomly divided into four groups. Group 1 received 0.9% NaCl; group 2 received 2% lidocaine; group 3 received 2% tetracaine; and group 4 received 4% articaine to the tonsillary bed for 5 min just after the operation. All patients were evaluated in terms of pain and pain-related adverse events in the postoperative 24 h. RESULTS: All groups that used local anesthetics had significantly lower pain levels than the control group in the first eight hours (p < .001). Furthermore, the articaine group had a lower pain score than the tetracaine group at the eighth hour (p < .05). The articaine group had a lower pain score at the 16th hour than both the control and tetracaine groups (p < .05). There was no significant difference between the groups at the 24th hour (p > .05). CONCLUSION AND SIGNIFICANCE: We recommend the immediate application of topical articaine to the tonsillar bed following the procedure to enhance postoperative pain management.
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Anestésicos Locales , Carticaína , Lidocaína , Dolor Postoperatorio , Tetracaína , Tonsilectomía , Humanos , Niño , Tetracaína/administración & dosificación , Carticaína/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Anestésicos Locales/administración & dosificación , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Masculino , Femenino , Tonsilectomía/efectos adversos , Estudios Prospectivos , Preescolar , Adolescente , Administración Tópica , Dimensión del Dolor , Método Doble CiegoRESUMEN
OBJECTIVES: To assess the extent of staff exposure to aerosol generation in common pediatric otorhinolaryngological procedures (tonsillotomies, adenoidectomies, and tympanostomies) and determine the surgical phases responsible for most aerosol generation in these procedures. METHODS: Aerosol generation was measured during 35 pediatric otolaryngological procedures using an Optical Particle Sizer that measures aerosol concentrations for particle sizes between 0.3 and 10.0 µm. The different phases of and instruments used in each procedure were logged. Operating room background aerosol levels and coughing were used as references. RESULTS: Total aerosol concentrations were significantly higher during tonsillotomies and adenoidectomies when compared to tympanostomies (p = 0.011 and p = 0.042) and to empty room background aerosol concentrations (p = 0.0057 and p < 0.001). Aerosol concentration during tonsillotomies did not differ from coughing, which is considered as standard for high-risk aerosol procedures. During tympanostomies, aerosol concentrations were even lower than during perioperative concentrations. No statistically significant difference in aerosol generation comparing suction, electrocautery, cold instruments, and paracentesis was found. CONCLUSION: According to the results of this study, tympanostomies are low-risk aerosol-generating procedures. On the other hand, pediatric tonsillotomies produced aerosols comparable to coughing, pointing to them being significantly aerosol-producing procedures and viral transmission is theoretically possible intraoperatively.
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Aerosoles , Humanos , Niño , Quirófanos , Exposición Profesional/análisis , Femenino , Masculino , Procedimientos Quirúrgicos Otorrinolaringológicos , Tonsilectomía/métodos , Tonsilectomía/instrumentación , Tamaño de la Partícula , AdenoidectomíaRESUMEN
INTRODUCTION: Orthodontic treatment using face mask protraction combined with an alternate rapid maxillary expansion and constriction/protraction face mask (Alt-RAMEC/PFM) protocol is effective in the early treatment of patients with class III malocclusion, but the stability of treatment outcomes represents a major concern. Previous studies have suggested that tonsillar hypertrophy can be a risk factor for class III malocclusion and tonsillectomy may prompt the normalisation of dentofacial growth. However, these studies had a low-to-moderate level of evidence. This study was designed to identify the impact of tonsillectomy before orthodontic treatment on the efficacy and stability of Alt-RAMEC/PFM protocols and the sleep quality and oral health in children with anterior crossbite and tonsillar hypertrophy. METHODS AND ANALYSIS: This is a two-arm, parallel-group, superiority cluster randomised controlled trial, with four clinics randomly assigned to the surgery-first arm and the orthodontic-first arm in a 1:1 ratio. The Alt-RAMEC protocol involves alternate activation and deactivation of the expander's jet screw over 6 weeks to stimulate maxillary suture distraction. Patients will be instructed to wear the PFM for a minimum of 14 hours per day. The primary outcomes are changes in Wits appraisal and the degree of maxillary advancement from baseline to the end of orthodontic treatment. Lateral cephalometric radiographs, polysomnography, Obstructive Sleep Apnoea-18 questionnaire and Oral Health Impact Profile-14 questionnaire will be traced, collected and measured. We will recruit 96 patients intofor the study. To assess differences, repeated multilevel linear mixed modelling analyses will be used. ETHICS AND DISSEMINATION: This study has been granted ethical approval by the Ethics Committee of the School & Hospital of Stomatology, Wuhan University (approval No. 2023-D10). Written informed consent will be obtained from the participants and their guardians. The results of the trial will be disseminated through academic conferences and journal publications. TRIAL REGISTRATION NUMBER: ChiCTR2300078833.
Asunto(s)
Hipertrofia , Maloclusión de Angle Clase III , Técnica de Expansión Palatina , Tonsila Palatina , Tonsilectomía , Humanos , Tonsilectomía/métodos , Niño , Maloclusión de Angle Clase III/cirugía , Maloclusión de Angle Clase III/terapia , Tonsila Palatina/patología , Tonsila Palatina/cirugía , Femenino , Aparatos de Tracción Extraoral , Ensayos Clínicos Controlados Aleatorios como Asunto , Masculino , Resultado del Tratamiento , Calidad del Sueño , AdolescenteRESUMEN
OBJECTIVE: To identify adverse events (AEs) related to suction electrocautery use during adenotonsillectomy. METHODS: The US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was searched using the terms "suction cautery," "suction electrocautery," "suction Bovie," and "suction coagulator" from January 2014 to December 2023. RESULTS: 165 AE reports were gathered from the MAUDE database medical device reports (MDRs). 36 met inclusion criteria. Patient injuries were found in 22 (61.1 %) reports and device malfunction events were found in 14 (38.9 %) reports. All patient injuries were thermal burns (N = 22, 100 %). Location of burn injuries included the lip (N = 6, 27.3 %), oral commissure (N = 5, 22.7 %), and tongue (N = 4, 18.2 %). The most common cause of an AE was inadequate device insulation (N = 7, 19.4 %). CONCLUSION: The suction electrocautery apparatus may malfunction and cause patient burn injuries. Device failures mainly result from inadequate device insulation, coagulation problems, and detachment of device components. Surgeons must be aware of these potential complications and counsel parents and patients regarding AEs.
Asunto(s)
Adenoidectomía , Bases de Datos Factuales , Electrocoagulación , Falla de Equipo , Tonsilectomía , Tonsilectomía/efectos adversos , Tonsilectomía/instrumentación , Humanos , Electrocoagulación/efectos adversos , Electrocoagulación/instrumentación , Adenoidectomía/efectos adversos , Adenoidectomía/instrumentación , Succión/instrumentación , Succión/efectos adversos , Estados Unidos , Falla de Equipo/estadística & datos numéricos , United States Food and Drug Administration , Quemaduras/etiologíaRESUMEN
Many research articles have explored the impact of surgical interventions on voice and speech evaluations, but advances are limited by the lack of publicly accessible datasets. To address this, a comprehensive corpus of 107 Spanish Castilian speakers was recorded, including control speakers and patients who underwent upper airway surgeries such as Tonsillectomy, Functional Endoscopic Sinus Surgery, and Septoplasty. The dataset contains 3,800 audio files, averaging 35.51 ± 5.91 recordings per patient. This resource enables systematic investigation of the effects of upper respiratory tract surgery on voice and speech. Previous studies using this corpus have shown no relevant changes in key acoustic parameters for sustained vowel phonation, consistent with initial hypotheses. However, the analysis of speech recordings, particularly nasalised segments, remains open for further research. Additionally, this dataset facilitates the study of the impact of upper airway surgery on speaker recognition and identification methods, and testing of anti-spoofing methodologies for improved robustness.
Asunto(s)
Habla , Voz , Humanos , Periodo Posoperatorio , Tonsilectomía , Masculino , Femenino , Periodo Preoperatorio , AdultoRESUMEN
Pediatric sleep-disordered breathing disorders are a group of common conditions, from habitual snoring to obstructive sleep apnea (OSA) syndrome, affecting a significant proportion of children. The present article summarizes the current knowledge on diagnosis and treatment of pediatric OSA focusing on therapeutic and surgical advancements in the field in recent years. Advancements in OSA such as biomarkers, improving continuous pressure therapy adherence, novel pharmacotherapies, and advanced surgeries are discussed.