Effect of dexamethasone on postoperative nausea and vomiting in children after tonsillectomy surgery

After approval by the local ethics committee sixty ASA 1 and 11 children, undergoing tonsillectomy surgery by dissection technique were included into the study. The parents of all children had been informed to the nature of the study and a written informed consent was obtained. The children who fulfilled our inclusion criteria were classified into three equal groups according to the timing of dexamethasone administration: Group I: Received dexamethasone 8mg IV one hour before induction of anesthesia. Group II. Received dexamethasone 8mg IV at the end of anesthesia. Group III: Received placebo [2 ml saline]. Anesthesia was managed in a standardized manner in the three groups. Postoperative pain was assessed by questioning the children on a visual analogue toy at one, two and, six hours postoperatively. Nausea and vomiting were assessed by 3 point ordinal scale: 0 = none. 1 = Nausea. 2 = Vomiting. Vomiting was assessed immediately after operation and was defined as forceful expulsion of gastric contents. Leach vomiting episode was counted in the operating room after the tracheal tube was removed. No distinction was made between vomiting and retching, [defined as active efforts without expulsion of gastric contents], and retching was graded as a vomiting event. The severity of vomiting episodes was recorded as: None [no emetic episode], Mild [1-3 episodes], Moderate [4-6 episodes], or Severe [> 7 episodes]. Vomiting was classified according to its time of occurrence after recovery as: none, early [within the first 180 minutes after the end of anesthesia], or delayed [after 180 minutes]. No vomiting and no rescue antiemetic medication during the 24 hour postoperative period were defined as successful protection. Surgery time, anesthesia time, need for rescue antiemetics, quality of oral intake in the PACU were recorded for each patient. Paracetamol suppositories 10 mg/kg 4-hourly were described for postoperative analgesia and on request of the patient, the total dose of paracetamol consumption was recorded. Our results showed that, at 0-2 hour postoperatively: Patients in group I reported a significantly less frequent incidence of PONV than those in group II and III with frequencies of 20%, 60% and 70% in group 1, II and III respectively. At 2-6 h postoperatively, no patient [0%]. Two patients]10%] and three patients [15%] suffered form vomiting in group I, II and III respectively. At 0-2h postoperatively, four patients [20%] in group I, and 12 patients [60%] in group II, and 14 patients [70%] in group III suffered vomiting early within 180 minutes after the end of anesthesia. At 2-6 hours postoperatively, no patient in group I suffered from vomiting, one patient [5%] in group II suffered vomiting early within 180 minutes after the end of anesthesia, and one patient [5%] in group II and 3 patients [15%] in group III had delayed vomiting after 180 minutes from the end of anesthesia. There were no children in group I who required antieienietic rescue while 4 patients [20%] in group II and 5 patients [25%] in group III required treatment with metoclopramide. Children in group I achieved early oral intake than the other two groups. We concluded that 8 mg IV dexamethasone, when administered 1 hour before the induction of anesthesia provided an effective antiemetic therapy throughout the first six hours of the postoperative period. On the other hand, dexamethasone when administred at the end of anesthesia, failed to provide an effective antiemetic therapy during the immediate postoperative period in children after tonsillectomy surgery

Treatment results of neo-adjuvant chemotherapy in advanced laryngeal carcinoma in upper Egypt

This study was carried out on eligible, previously untreated patients with local and advanced laryngeal carcinoma. A maximum of three cycles of chemotherapy was given, followed by local treatment according to the degree of response. This study included 31 eligible patients. Stage III disease was reported in 52% of the cases and stage IV reported in 48%. The assessment after neoadjuvant chemotherapy showed an overall response in 65% of the patients, a complete response [CR] in 23% and a partial response [PR] in 42%. Stable disease [SD] was found in 19% and progressive disease [PD] in 16%. Six patients underwent post-chemotherapy total laryngectomy and 20 patients had radical radiotherapy. After the completion of local treatment, CR was reported in 20 out of the 26 patients and PR in 6 patients. The preservation of larynx was achieved in 20 patients of the whole studied group. The disease free period [DFP] was significantly affected by the primary response to chemotherapy and tumor stage. The overall survival [OS] was not significantly detected by chemotherapy or method of local treatment

Spirometric lung function changes after total laryngectomy

In this study, repeated pulmonary function tests were studied in 20 patients with laryngeal carcinoma at 3 days before total laryngectomy, and 2 and 6 months after the operation, using a special extratracheal device in order to assess the effect of removal of the larynx on the pulmonary function and the possibility of management of treatable pulmonary function abnormalities. The present study aimed to determine if the newly designed extratracheal device used in the study enables and facilitates flow volume and resistance measurements performed with spirometric study. Also, the effect of bronchodilator for reversibility of airway obstruction in laryngectomized patients was studied. Finally, the compatibility of the data obtained from a questionnaire with the findings obtained from spirometric lung function was assessed. The results obtained in the present study revealed that in laryngectomized patients, expiratory lung functions were lower than the predicted values. Bronchodilator treatment was found to ameliorate some pulmonary function parameters in ten patients. The value of extratracheal device used was discussed

Relevant factors in the identification of hearing loss in children of upper Egypt

This study was designed to examine factors which can affect early identification of hearing loss in children of Upper Egypt. The medical records of 252 children with significant hearing loss were studied. Information about each child's degree and type of hearing loss, cause of hearing loss, source of referral, additional handicaps, age of suspicion of loss, age of identification and time of hearing aid fitting were collected. Children with a greater degree of hearing loss, additional medical problem or additional handicap were identified earlier than those without these factors. In addition, children with positive family history of hearing loss were also detected earlier than those with negative family history. This study showed that hearing impaired children in Upper Egypt were identified and fitted with hearing aids at age older than that recommended for proper rehabilitation

CO2 laser in treatment of rhinoscleroma: preliminary study

Twelve patients proved histopathologically to have rhinoscleroma were treated with CO2 laser. They were five patients in the fibrotic stage, six in the granulomatous stage and one patient in the healed fibrotic stage in one side of the nose and granulomatous in the other. In fibrotic lesions, pulsed and superpulsed modes were used with 18 to 20 watts, while in granulomatous lesions continuous mode with 20 to 25 watts were used. All patients complained of bilateral complete persistent nasal obstruction. All patients were operated upon under general anesthesia apart from one with cardiac ischemia who was operated upon under local anesthesia. The procedure could be well tolerated. Three patients with extensive lesions involving the choanae needed two sitting. No immediate complications were met with apart of insignificant burns to the vestibule unilaterally in only three patients. No bleeding apart of slight bleeding in one granulomatous lesion was found. Nasal patency was achieved bilaterally in all patients who were followed up for at last one year except of a girl with extensive granulomatous lesion involving the choana and nasopharynx. CO2 laser is a valid and safe adjuvant to the treatment of scleroma in the fibrotic stage. In patients with extensive granulomatous lesions with involvement of the choana and nasopharynx, CO2 laser could be used to debulk the lesions in combination to conventional surgery. This could shorten the time and limit laser use

Co2 laser in treatment of laryngoscleroma: preliminary study

Twelve patients proved histopathologically to have rhinoscleroma were treated with CO2 laser. They were five patients in the fibrotic stage, six in the granulomatous stage and one patient in the healed fibrotic stage in one side of the nose and granulomatous in the other. In fibrotic lesions, pulsed and superpulsed modes were used with 18 to 20 watts, while in granulomatous lesions continuous mode with 20 to 25 watts were used. All patients complained of bilateral complete persistent nasal obstruction. All patients were operated upon under general anesthesia apart from one with cardiac ischemia who was operated upon under local anesthesia. The procedure could be well tolerated. Three patients with extensive lesions involving the choanae needed two sitting. No immediate complications were met with apart of insignificant burns to the vestibule unilaterally in only three patients. No bleeding apart of slight bleeding in one granulomatous lesion was found. Nasal patency was achieved bilaterally in all patients who were followed up for at last one year except of a girl with extensive granulomatous lesion involving the choana and nasopharynx. CO2 laser is a valid and safe adjuvant to the treatment of scleroma in the fibrotic stage. In patients with extensive granulomatous lesions with involvement of the choana and nasopharynx, CO2 laser could be used to debulk the lesions in combination to conventional surgery. This could shorten the time and limit laser use

Central skull base lesions presenting as unilateral proptosis

Twenty-one patients presented with unilateral proptosis were studied. Computed tomography and sinoscopy were done to all patients. These patients were distributed as followed; four patients with central cranial base lesions, one was nasopharyngeal carcinoma with intracranial extension, one nasopharyngeal fibroma, two osteomas, two recurrent nasal polyposis, four mucoceles, six nasal ethmoidal cancer and one chronic ethmoiditis. The importance of CT and sinoscopy in diagnosis of central base lesions was demonstrated. Central cranial skull base lesions should be considered in cases of unilateral proptosis especially if the lesion is not clinically evident. CT and sinoscopy are indispensable tools in diagnosis and management of patients presented with unilateral proptosis especially those without evident local lesions

Endoscopic intranasal ethmoidectomy and transantral Et hmoidectomy guided with sinoscopy in treatment of patients with recurrent nasal polyposis: Comparative study

Thirteen patients with recurrent nasal polypi were treated in ENT department, Assiut University hospital with two types of ethmoidectomies. Twelve intranasal endoscopic ethmoidectomies and thirteen transantral ethmoidectomies guided with sinoscopy were done to to those patients. results and complications of both modalities were compared. No major complication was recorded for both mothods. Complete recurrence was near to each other [8% Vs 7%]. Partial recurrence for internasal endoscopic ethmoidectomy is double that for transantral ethmoidectomy guided with sinoscopy [34% Vs 17%]