Postoperative pulmonary complications following adenotonsillectomy in pediatric patients with obstructive sleep apnea in a tertiary government hospital

Objective@#Our study aimed to identify and describe pulmonary complications and its associated risk factors in children with suspected or confirmed obstructive sleep apnea (OSA) who underwent tonsillectomy or adenotonsillectomy in a tertiary government hospital.@*Methods@#We conducted a retrospective cohort study. Medical charts of pediatric patients with suspected or confirmed OSA who were admitted for tonsillectomy or adenotonsillectomy from January 1, 2016 to December 31, 2020 were retrieved and reviewed. Information of the individual patients including the demographic data, clinical profile, polysomnography results, and presence of postoperative pulmonary complications were recorded. Descriptive statistics was utilized to present continuous data while frequency and percentage for categorical data. Fisher exact test was used to compare the demographic profile of patients with postoperative pulmonary complications from those without. @*Results@#A total of 90 patient records were analyzed. The mean age of the patient population was 7.87 years, 55.6% were male, 17.8% of patients were classified as obese. Thirty-four children had preoperative polysomnography and of these, 47.1% were classified as severe. Only two (2.2%) patients had postoperative pulmonary complications, which were bronchospasm and desaturation, respectively. There were no statistically significant differences noted in comparing the clinicodemographic profile of patients with postoperative pulmonary complications from those without complications. @*Conclusion@#Our results showed that most pediatric patients with suspected or confirmed OSA who underwent adenotonsillectomy did not have pulmonary complications.

Advances in the relationship between obstructive sleep apnea and enuresis in children / 国际儿科学杂志

Enuresis(NE)and obstructive sleep apnea(OSA)are common diseases in children, which often cause various social and psychological problems and the coexistence of both seriously affects the physical and mental health of children.At present, there have been many speculations about whether OSA can cause NE and the specific pathogenesis.OSA may be susceptible to NE due to abnormal secretion of humoral factors, sleep-wake disorders, bladder dysfunction, obesity, and psychosomatic factors, among which abnormal secretion of humoral factors and sleep-wake disorders may play a crucial role.In addition, it has been suggested that adenotonsillectomy may be the best treatment option for children suffering from OSA with NE when upper airway obstruction is present.This article summarizes the relationship between NE and OSA and how to treat them, aiming to provide a reference for the clinical treatment of OSA and NE.

A study of Cardiorespiratory Parameters and Sleep Architecture in Patients with Pediatric Obstructive Sleep Apnea undergoing Adenotonsillectomy

Background: Obstructive sleep apnea (OSA) in pediatric population is associated with cardiac, respiratory, metabolic, neurocognitive, and behavioral dysfunctions. Adenotonsillectomy (AT) is the treatment of choice in children who have hypertrophied adenoid and/or palatine tonsils. However, there is paucity of literature on the impact of AT on cardiorespiratory and sleep parameters in these cases. Methods: We did a retrospective study on children who had undergone AT from July 2016 to December 2018 at a tertiary hospital in north India. Only those children, whose polysomnography (PSG) was available both before and after AT were enrolled in this study. � Cardiac parameters: Mean heart rate (MHR) and highest heart rate (HHR), number and duration of arrhythmias, and pulse transit time (PTT) drops. � Respiratory parameters: Apnea-hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), mean oxygen saturation (MOS). � Sleep parameters: Time spent in different stages, sleep efficiency (SE), and arousal index (AI) on PSG were compared before and after AT. Results: A total of 56 children had undergone AT for OSA. Also, PSG, both before and after AT, was available in 37 children. After excluding children having undergone other surgeries for OSA and those with comorbidities, 32 children were enrolled. AT led to significant positive change in AHI (from 7.86 � 7.91 to 2.03 � 3.10, p = 0.01), RDI (from 16.319 � 15.64 to 7.38 � 3.72, p < 0.01), AI (from 22.10 � 14.93 to 15.90 � 8.48, p = 0.012), SE (from 91.47 � 6.31 to 95.866 � 3.03, p < 0.01), ODI (from 6.7959 � 5.03 to 1.865 � 2.09, p < 0.01), MOS (from 95.59 � 2.19 to 97.28 � 1.27), HHR (from 141.68 � 17.93 to 120.93 � 16.98, p < 0.01), MHR (86.68 � 12.95 to 80.29 � 8.81, p = 0.01), and PTT AI (from 36.67 � 27.72 to 26.93 � 24.86, p < 0.01). There was no non-sinus wide or narrow complex tachyarrhythmia in any child before or after AT. There was no statistically significant change in rapid eye movement (REM) sleep duration or number and duration of bradycardia episodes in these children (p > 0.05). Conclusion: Adenotonsillectomy improved SE and oxygenation, and decreased the number of obstructive events, arousals, heart rate, and PTT AI during sleep in children with OSA. Some children had residual disease after surgery. Heart rate and PTT can be excellent non-invasive parameters for detecting obstructive events during sleep in children and monitoring the impact of various therapeutic modalities.

Is There a Difference between the Preoperative and Postoperative Serum Levels of Interleukin-6 and Tumor Necrosis Factor-α in Children Submitted to Adenotonsillectomy?

Abstract Introduction Palatine and pharyngeal tonsils are the first line of defense against pathogens. Clinically, two alterations may require surgical removal of the tonsils: hypertrophy and recurrent tonsillitis. The two conditions probably result from a dysfunction of the immune system. Objective To evaluate possible differences in the plasma levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) in patients submitted to adenotonsillectomy. Methods Prospective, longitudinal study with 25 children undergoing adenotonsillectomy separated into 3 different groups: recurrent tonsillitis (RT), composed of 7 patients; recurrent hypertrophy tonsillitis (RTTH), with 8 patients; and the tonsillar hypertrophy (TH) group, with 10 patients. Ten healthy control children (SD) were also included in the study. Peripheral blood was collected, and plasma was separated to measure the levels of TNF-α, IL-6, and IL-10. The Mann-Whitney test was used for statistical analysis. Results The plasma level of IL-6 was higher in the RT (p= 0.0394) and TH (p= 0.0009) groups, compared with the control group. The TH group also had higher levels of IL-6 than the RT group (p= 0.039). The IL-6/IL-10 ratio was higher in the RT (p= 0.029) and TH (p= 0.0005) groups compared with the control group. Between the RT and RTTH groups, the IL-6/IL-10 ratio was higher in the RT group, with a statistically significant difference (p= 0.0091). Conclusion Patients with a history of chronic tonsillitis had higher levels of IL-6, compared with the control group.

Audit of Adenotonsillar surgeries in a Tertiary Facility in Uyo, South-south Nigeria

Background:Adenoid and tonsils are lymphoid tissues that occupy the nasopharynx and tonsillar fossae and serve as the initial site of immunological contact for inhaled and ingested antigens. Adenoidectomy, tonsillectomy or adenotonsillectomy is a lifesaving surgical procedure and remains a leading reason of surgical admission in general otorhinolaryngological practice both in developed and developing countries.The study aims to audit adenotonsillar surgeries in the Department of Ear, Nose and Throat in University of Uyo Teaching Hospital, and compare findings with similar studies.Method:This is a retrospective study of patients who had adenoidectomy, tonsillectomy, or adenotonsillectomy over 5 years from January 2015 to December 2019 at the Department of Ear, Nose, and Throat, University of Uyo Teaching Hospital, Uyo, Akwa Ibom state, south-south Nigeria.Results:Atotal of 526 patients were recruited, and this accounted for 38.7% of the total ENTsurgeries performed within the study period. Ages ranged from 6 months to 72 years, with a mean age of 11.89+1.03. The majority of the patients were aged between 1-5 years and the commonest presenting symptom was snoring and mouth breathing (79.5%). Sleep-disordered breathing (55.7%) was the main indication for the surgeries. Adenotonsillectomy (61.0%) was the commonest surgery performed. About 1.0% of the patients had recurrent adenoids. Conclusion: The surgeries were of immense necessity to the patients as all presenting complaints and pre-operative diagnoses became completely resolved.

Impact of adenotonsillectomy on the quality of life of patients operated on at the Hospital de Clínicas, Paraguay / Impacto de la amigdalectomía en la calidad de vida de los pacientes operados en el Hospital de Clínicas, Paraguay

The objective of this study is to determine the impact of adenotonsillectomy on the quality of life of postoperative patients. The study is observational, cross-sectional, and retrospective. The files of all postoperative adenotonsillectomy patients in Otorhinolaryngology Service, Hospital de Clínicas, San Lorenzo Paraguay. The Obstructive sleep apnea ­ 18 questionnaire (OSA 18) was applied, asking patients about symptoms before and after surgery. An effective sample of 143 postoperative patients was obtained. The average age was 6.05 ± 2.08 years, 55.10% (81) were male and 44.89% (66) were female, 65.30% (96) were from urban areas and 34.69% (51) from the rural areas. The t test was performed for means of two paired samples, comparing the results of the Obstructive sleep apnea ­ 18 questionnaire surveys before and after surgery which presented a significant difference (p <0.05) with a tendency to improve the quality of life after surgery. It has been shown that there is a significant difference, a considerable improvement in the quality of life of patients after adenotonsillectomy

El objetivo de este estudio fue determinar el impacto de la adenoamigdalectomía en la calidad de vida de los pacientes postoperados. Se diseñó un estudio observacional, transversal y retrospectivo. Se revisaron los expedientes de todos los pacientes postoperados de adenoamigdalectomía en el servicio de otorrinolaringología del Hospital de Clínicas de san Lorenzo, Paraguay, se aplicó el cuestionario de apnea obstructiva del sueño ­ 18 (AOS 18), en el que se preguntaba a los pacientes sobre los síntomas antes y después de la cirugía. Se obtuvo una muestra efectiva de 143 pacientes postoperatorios. La edad media fue de 6,05 ± 2,08 años, el 55,10% (81) eran hombres y el 44,89% (66) eran mujeres, el 65,30% (96) eran de zonas urbanas y el 34,69% (51) de zonas rurales. Se realizó la prueba t para medias de dos muestras pareadas, comparando los resultados de la encuesta del cuestionario de apnea obstructiva del sueño - 18 antes y después de la cirugía que presentó una diferencia significativa (p <0,05) con tendencia a mejorar la calidad de vida después de la cirugía. El estudio muestra una mejora considerable en la calidad de vida de los pacientes tras la adenoamigdalectomía.

Síndrome de apnea obstructiva del sueño persistente en niños adenoamigdalectomizados: artículo de revisión

Resumen El síndrome de apnea e hipoapnea obstructiva del sueño (SAHOS) en niños forma parte del espectro de trastornos respiratorios del sueño en la infancia. Tiene una prevalencia entre un 0,69% y 4,7% en la población infantil con una mayor incidencia entre los 2 y 6 años debido principalmente a la hiperplasia adenoamigdaliana y constituye una importante causa de morbilidad neurocognitiva y conductual en quienes lo padecen. El principal tratamiento quirúrgico del SAHOS infantil lo constituye la adenoamigdalectomía, cirugía que logra la resolución de los síntomas entre un 20% y 75% de los pacientes. Los pacientes con comorbilidades asociadas tales como obesidad, enfermedades neuromusculares y alteraciones craneofaciales, entre otras, tienen mayor riesgo de SAHOS persistente. En la presente revisión de la literatura abordaremos el diagnóstico, enfrentamiento, estudio y tratamiento del SAHOS persistente posadenoamigdalectomía en niños.

Abstract Obstructive sleep apnea syndrome (OSA) in children is part of the spectrum of respiratory sleep disorders in childhood. It has a prevalence between 0.69 and 4.7% in pediatric population, with a higher incidence between 2 and 6 years old, mainly due to adenotonsillar hyperpla-sia. OSA constitutes an important cause of neurocognitive and behavioral morbidity. The main surgical treatment for childhood OSA is adenotonsi-llectomy, which resolves symptoms in 20%-75% of patients. Patients with associated comorbidities such as obesity, neuromus-cular diseases, and craniofacial malformations are at higher risk of having persistent OSA. In this literature review, we will discuss the diagnosis, evaluation and treatment of persistent OSA after adenotonsillectomy in children.

Crescimento pôndero-estatural de crianças e adolescentes submetidos à adenoamigdalectomia / Weight and height growth of children and adolescents after adenoton sillectomy

Objetivo: documentar de forma sistemática o padrão de desenvolvimento pôndero-estatural de pacientes submetidos à adenoamigdalectomia. Métodos: coleta de dados secundários dos prontuários de pacientes atendidos no ambulatório de Otorrinolaringologia Pediátrica, antes e depois da cirurgia de adenoamigdalectomia. Resultados: de forma individual, os pacientes apresentaram elevação no escore Z e percentis das variáveis ao peso e a altura no período entre as análises. Especificamente em relação ao peso, a média antes do procedimento e quatro meses depois do procedimento foi, respectivamente, de 29,1 kg e 32,8 kg; no que diz respeito à altura, a média foi de 1,22 m e 1,25 m, respectivamente. Ao aplicar o Teste T de Student foi possível notar significância estatística para ambas as variáveis em estudo. Aspecto não percebido ao avaliar os indivíduos reunidos em grupos etários (pré-escolares, escolares e adolescentes). Conclusões: as crianças submetidas à adenoamigdalectomia apresentaram ganho pôndero-estatural após a cirurgia. A atuação cirúrgica diante do diagnóstico da hipertrofia e da hiperplasia das amígdalas e tonsila faríngea deve ser precoce, desde que haja indicação formal, a fim de evitar a manutenção do atraso no crescimento nesses pacientes.

Aims: to systematically document weight and height development in children after adenotonsillectomy. Methods: analysis of secondary data from the Pediatric Otorhinolaryngology clinic patient's medical records before and after adenotonsillectomy. Results: regarding weight, the average before the procedure and four months and the average after the procedure were, respectively, 29.1 kg and 32.8 kg; as regards height, the averages were 1.22 m and 1.25 m, respectively. By applying the Teste T de Student it was possible to notice statistical significance for both variables under study. Conclusions: children exhibited statistically significant weight and height gain after surgery. Surgical treatment should be performed early after the diagnosis of pharyngeal tonsil and tonsils hypertrophy and hyperplasia provided in case of a formal indication in order to avoid the maintenance growth retardation in these patients.

Interpretation of French Society of ENT guidelines on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

Summary@#The French Society of ENT and Head Neck Surgery（SFORL）present the guidelines on the roles of the various treatment options in childhood obstructive sleep apnea in May 2018，this paper is the interpretation of the guidelines.

Interpretation of French Society of ENT guidelines on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

The French Society of ENT and Head Neck Surgery（SFORL）present the guidelines on the roles of the various treatment options in childhood obstructive sleep apnea in May 2018，this paper is the interpretation of the guidelines.

Estenosis faríngea secundaria a adenoamigdalectomía: ¿cómo la resolvemos? / Pharyngeal stenosis secondary to adenotonsillectomy: how do we solve it?

RESUMEN La estenosis faríngea es una complicación muy poco frecuente de la adenoamigdalectomía. Consiste en un estrechamiento de la vía aerodigestiva superior secundaria a la adhesión parcial o total de las estructuras que componen la orofaringe producto de una disección extensa al realizar amigdalectomía. El objetivo de este trabajo es presentar tres casos clínicos tratamiento y correspondiente técnica quirúrgica. Se describen tres pacientes operados durante la edad preescolar de adenoamigdalectomía, que cursaron en el posoperatorio con estenosis faríngea. Todos presentaron roncopatía severa, respiración oral y resonancia hiponasal. La nasofibroscopía evidenció estrechez faríngea en distintos grados. A todos se les realizó resección del tejido cicatricial y faringoplastía con colgajo miomucoso y posterior rehabilitación con bulbo faríngeo. El uso de colgajos faríngeos posterior a la liberación de adherencias posadenoamigdalectomía permite aportar tejido sano a zonas cruentas, evitando la formación de nuevas adherencias y restituyendo la permeabilidad oronasal. El bulbo faríngeo es fundamental para mantener un apropiado lumen y manejo de la cicatrización en el posoperatorio. La técnica de colgajo faríngeo lateral, que interpone mucosa faríngea sana para la cobertura del lecho cruento, constituye una alternativa quirúrgica eficaz para resolver la estenosis faríngea posquirúrgica.

ABSTRACT Pharyngeal stenosis is a very rare complication of adenotonsillectomy. It is caused by a narrowing of the upper aerodigestive pathway secondary to the total or partial adhesion of the retropharyngeal structures as a result of extensive dissection during tonsillectomy. Our aim is to present three consecutive clinical cases of pharyngeal stenosis after adenotonsillectomy, discuss its treatment and corresponding surgical technique. We present three infants with adenotonsillectomy with postoperative pharyngeal stenosis. All had severe snoring, oral breathing and hyponasal resonance. The nasofibroscopy showed pharyngeal obliteration in several degrees. All patients underwent scar tissue resection and pharyngoplasty with myomucosal flap and subsequent use of pharyngeal bulb. The use of pharyngeal flaps after release of pharyngeal adhesions allows to provide healthy tissue to row areas, avoiding new postoperative adhesions and providing adequate oronasal permeability. The pharyngeal bulb is essential to maintain permeability and management of scarring in the postoperative period. The technique of lateral pharyngeal flap, which aims to interpose healthy pharyngeal mucosa to cover the bloody bed, is an effective therapeutic alternative to solve post-surgical pharyngeal stenosis.

Leucotrienos urinarios en pacientes pediátricos con trastorno respiratorio del sueño secundario a hiperplasia adenoamigdalina / Urinary leukotrienes in pediatric patients with sleep disordered breathing secondary to adenotonsillar hypertrophy

RESUMEN Introducción: El trastorno respiratorio del sueño (TRS) afecta al 2% a 3% de la población pediátrica, siendo la hiperplasia adenoamigdalina (HAA) su principal causa. Se ha observado un aumento en los niveles de leucotrienos excretados en orina (LTU) en estos pacientes, los cuales se correlacionarían con la severidad de la enfermedad. Objetivo: Determinar el nivel de LTU en niños con TRS e HAA antes y después de adenoamigdalectomía (AA), y en controles sanos. Correlacionar los niveles de LTU con los síntomas de TRS. Material y método: Estudio prospectivo. Se incluyeron pacientes con TRS e HAA (n =12) y controles sanos (n =12). Se determinó la concentración de LTU en ambos grupos de forma basal y un mes después de cirugía en el grupo con TRS. Resultados: No hubo diferencias en los niveles de LTU antes y después de AA. Tampoco existieron diferencias entre el grupo control y grupo TRS previo a la cirugía. No se encontró asociación entre LTU y la severidad de síntomas respiratorios. Conclusión: Los LTU no se encuentran elevados en pacientes con TRS e HAA, no disminuyen luego de AA y no se correlacionan con la severidad de los síntomas. La medición de LTU no sería una herramienta útil en la evaluación de pacientes con TRS. Nuevos estudios son necesarios para evaluar el rol de los leucotrienos en esta enfermedad.

ABSTRACT Introduction: Sleep disorder breathing (SDB) affects 2%-3% of the pediatric population, being adenotonsillar hyperplasia (ATH) its main cause. An increase in the levels of urinary leukotrienes (ULT) has been measured in these patients, which could be correlated with the severity of the disease. Aim: To determine the level of ULT in children with SDB and ATH before and after adenotonsillectomy, and healthy controls. To correlate the levels of ULT with symptoms of SDB. Material and method: prospective study. SDB and ATH patients (n =12) and healthy controls (n =12) were included. The concentration of ULT in both groups was determined, before surgery and after a month of surgery. Results: There were no differences in the levels of ULT before and after tonsillectomy in the studied group. There were also no differences between the control group and the SDB group. No association was observed between the level of ULT and the severity of respiratory symptoms. Conclusions: ULT are not elevated in patients with SDB and ATH and they do not decrease after adenotonsillectomy. ULT are not correlated with the severity of the symptoms of SDB. The measurement of ULT would not be a useful tool in the evaluation of patients with SDB. New studies are needed to assess the role of the role of leukotrienes in this disease.

The randomised prospective comparative study to see the duration of analgesia following intravenous or rectal acetaminophen after adenotonsillectomy in children

Background: The greatest advance in pediatric pain medicine is the recognition that untreated pain is a significant cause of morbidity and even mortality after surgical trauma. Author compared the analgesic efficacy and duration of analgesia of rectal acetaminophen and I.V. acetaminophen.Methods: A total of 80 children in the age group of 2-5 years were randomly selected and divided into 2 groups. Group I received 15 mg/kg I.V. paracetamol and group II received 40 mg/kg rectal acetaminophen. Post-operative pain scores were measured using Face, Legs, Activity, Cry and Consolability scale and duration of analgesia were recorded and compared.Results: The pain scores in group I was lower immediately after extubation and at 30 minutes post extubations but at one, two and four hours the pains score were comparable in both the groups. At 6 hours, the pain score was significantly more in I.V. group and also the duration of analgesia was 9-10 hours in rectal acetaminophen group where as in I.V. group, it was 5-6 hours.Conclusions: Rectal acetaminophen 40 mg/kg produces prolonged analgesia as compared to I.V. paracetamol 15 mg/kg and also is more convenient and cost effective and is devoid of side effects of I.V. cannulation.

Analysis of polysomnography results between pre- and post-operation in pediatric obstructive sleep apnea hypopnea syndrome patients / 中华耳鼻咽喉头颈外科杂志

Objective@#To determine the objective effects of adenotonsillectomy on pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) through analyzing the polysomnography (PSG) results between pre and post-operation.@*Methods@#A total of 56 pediatric OSAHS patients were included who underwent adenoidectomy or/and tonsillectomy and completed PSG follow-up from January 1, 2017 to March 31, 2018. All the pediatric patients who underwent adenoidectomy or/and tonsillectomy during the research period were arranged to take a preoperative PSG study. Patients who were diagnosed OSAHS would be encouraged to complete a follow-up PSG study ranged from1 to 3 months after surgery. The parameters of respiration and sleep architecture of PSG were compared and analyzed. The paired student t test was used to compare preoperative and postoperative mean values. The unpaired student t test was used to compare quantitative variables among different groups. The rank sum test was used if the data were abnormal distribution.@*Results@#Totally 238 patients completed preoperative PSG study, 62 patients were diagnosed as pediatric OSAHS, 56 eligible patients finished post-operative PSG. Hypopnea was the majority in all type of respiratory events in 56.45% (35/62) subjects, while central apnea as the majority in 29.03% (18/62) subjects who can also get significant CAI decrease after surgery. However, obstructive apnea as the majority only exist in 14.52% (9/62) subjects. The short-term cure rate of pediatric OSAHS was 85.71% (48/56). The postoperative AHI, MAI, CAI, HI, ODI, LoSpO2, percentage of stage I sleep and arousal index were significantly decreased, however, the OAI was no statistical decrease. The percentage of stage Ⅱ and rapid eye movement (REM) sleep were significantly increased, while no significant change in percentage of slow wave sleep and sleep efficiency(t=2.32, P=0.017).@*Conclusions@#Pediatric OSAHS manifest different characteristics of respiratory events from that of adults. Adenotonsillectomy can significant decrease respiratory events and improve sleep architecture, however, there are still some patients who can′t be completely relieved with adenotonsillectomy.

Influencia del exceso de peso en el éxito de la adenoamigdalectomía en pacientes con hiperplasia adenoamigdalina sintomática / The influence of overweight in the success of adenotonsillectomy in patients with adenotonsillar symptomatic hyperplasia

Resumen Introducción: En población pediátrica con malnutrición por exceso, existe controversia respecto al rol de la hiperplasia adenoamigdalina en la etiología de los trastornos del sueño y de la efectividad de la adenoamigdalectomía sobre dicha sintomatología. Objetivo: Comparar la efectividad de la adenoamigdalectomía entre pacientes pediátricos eutróficos y con malnutrición por exceso sometidos a adenoamigdalectomía por hiperplasia adenoamigdalina, en relación a la disminución de la sintomatología. Materiales y método: Estudio retrospectivo mediante revisión de fichas clínicas entre junio de 2016 y enero de 2017 de pacientes operados de adenoamigdalectomía por hiperplasia adenoamigdalina sintomática. Se clasificaron los pacientes de acuerdo a edad y estado nutricional en 4 grupos y se evaluó la resolución de la sintomatologia mediante interrogación a padres/tutores. Resultados: Se incluyeron 98 pacientes, con una edad media de 6,3 años. 44,9% de los pacientes fueron eutróficos y 55,1% con malnutrición por exceso. El análisis estadístico entre pacientes eutróficos y aquellos con malnutrición no demostró diferencias significativas en relación a la resolución de la sintomatología. Conclusión: La adenoamigdalectomía por hiperplasia adenoamigdalina sintomática se asocia a una reducción de la frecuencia de roncopatía con pausas en pacientes pediátricos, independientemente del estado nutricional.

Abstract Introduction: In pediatric population with malnutrition by excess, the role of the adenotonsillar hyperplasia in the etiology of breathing-related sleep disorders, and the effectivity of the adenotonsillectomy for reducing symptoms remains controversial. Aim: To compare and evaluate the effectiveness of the adenotonsillectomy between eutrophic and malnutrition by excess pediatric patients submitted to adenotonsillectomy by adenotonsillar hyperplasia, regarding to symptoms resolution. Material and method: A retrospective study was performed collecting data from clinical records between June 2016 and January 2017 of patients submitted to adenotonsillectomy by symptomatic adenotonsillar hyperplasia. Patients were assigned to 4 groups according to age and nutrional status and the rate of symptoms resolution was evaluated through interrogation to parents/guardians. Results: We included 98 patients, with an average age of 6.3 years. A 44.9% of patients were eutrophic and 55.1% had malnutrition by excess. Comparing eutrophic and malnutrition by excess patients, no significant differences were observed regarding to symptoms resolution. Conclusion: The adenotonsillectomy by symptomatic adenotonsillar hyperplasia was associated to an amelioration of the rate of snoring and respiratory pauses during sleeping in pediatric patients, independently of the nutritional status.

The improvement of right ventricular function after adenotonsillectomy in children with obstructive sleep apnea / 소아과

PURPOSE: Adenotonsillar hypertrophy (ATH) that causes upper airway obstruction might lead to chronic hypoxemic pulmonary vasoconstriction and right ventricular (RV) dysfunction. We aimed to evaluate whether adenotonsillectomy (T&A) in children suffering from obstructive sleep apnea (OSA) due to severe ATH could improve RV function. METHODS: Thirty-seven children (boy:girl=21:16; mean age, 9.52±2.20 years), who underwent T&A forsleep apnea due to ATH, were included. We analyzedthe mean pulmonary artery pressure (mPAP), the presence and the maximal velocity of tricuspid regurgitation (TR), the tricuspid annular plane systolic excursion (TAPSE), and the right ventricular myocardial performance index (RVMPI) with tissue Doppler echocardiography (TDE) by transthoracic echocardiography pre- and post-T&A. The follow-up period was 1.78±0.27 years. RESULTS: Only the RVMPI using TDE improved after T&A (42.18±2.03 vs. 40±1.86, P=0.001). The absolute value of TAPSE increased (21.45±0.90 mm vs. 22.30±1.10 mm, P=0.001) but there was no change in the z score of TAPSE pre- and post-T&A (1.19±0.34 vs. 1.24±0.30, P=0.194). The mPAP was within normal range in children with ATH, and there was no significant difference between pre- and post-T&A (19.6±3.40 vs. 18.7±2.68, P=0.052). There was no difference in the presence and the maximal velocity of TR (P=0.058). CONCLUSION: RVMPI using TDE could be an early parameter of RV function in children with OSA due to ATH.

Neuropsychological Functioning after Adenotonsillectomy in Children with Obstructive Sleep Apnea: A Meta-analysis / 华中科技大学学报（医学）（英德文版）

The present study aimed to investigate the efficacy of adenotonsillectomy (AT) for children with obstructive sleep apnea syndrome (OSAS) and the improvement of their cognitive function.Studies on cognitive performance of OSAS children treated with or without AT were identified by searching the Pubmed,EMBASE and Cochrane library.A meta-analysis was conducted to analyze the literature.The random-effects model was used to evaluate 11 eligible studies using an inverse-variance method.The neuropsychological test results of 4 cognitive domains (general intelligence,memory,attention-executive function and verbal ability) were obtained and analyzed.By comparison of cognitive function between OSAS children and healthy controls,the effect sizes of each domain were achieved as follows:general intelligence,-0.5 (P＜0.0001);memory,-0.18 (P=0.02);attention-executive function,-0.21 (P=0.002);and verbal ability,-0.48 (P=0.0006).The effect sizes of general intelligence,memory,attention-executive function,and verbal ability after AT compared to baseline level were-0.37 (P=0.008),-0.36 (P=0.0005),-0.02 (P=0.88),and-0.45 (P=0.009),respectively.Comparing the cognitive ability between OSAS children after AT and healthy controls showed that the effect sizes were-0.54 (P=0.0009),-0.24 (P=0.12),-0.17 (P=0.35),and-0.45 (P=0.009) in general intelligence,memory,attention-executive function,and verbal ability,respectively.Our results confirmed that OSAS children performed worse than healthy children in terms of the 4 cognitive domains investigated.After 6-12 months of observation,significant improvement in attention-executive function and verbal ability were found in OSAS children treated with AT compared to their baseline level;restoration of attention-executive function and memory were observed in OSAS children after AT in comparison to healthy controls.Further rigorous randomized controlled trials should be conducted to obtain definitive conclusions.

Two Cases of Pediatric Obstructive Hypoventilation Managed with Upper Airway Surgery

Sleep-disordered breathing in children can include habitual snoring, obstructive hypoventilation, upper airway resistance syndrome, and obstructive sleep apnea. Obstructive hypoventilation in children is characterized by CO₂ retention caused by prolonged partial upper airway obstruction during sleep. To date, there have been few studies regarding the clinical significance and management strategies in pediatric obstructive hypoventilation, although it is a unique feature of pediatric sleep-disordered breathing. In this report, we describe two cases of obstructive hypoventilation that demonstrated improvement following upper airway surgery. These results suggest that upper airway surgery could be an additional treatment modality in obstructive hypoventilation.

Preemptive Analgesic Effect of Two Doses of Ketamine for Postoperative Pain Relief in Children Following Adenotonsillectomy / 医学研究杂志

Objective To investigate the efficacy of two low doses of ketamine for postoperative pain relief in children following adenotonsillectomy.Methods Ninety ASA physical status Ⅰ patients,aged 2-9 years,scheduled for adenotonsillectomy were enrolled in this randomized,double-blinded study.Patients were divided into three groups of 30 each and received an intravenous injection of 0.9％ saline (group C),ketamine 0.2mg/kg (group K1),or ketamine 0.5mg/kg (group K2).FLACC scores were used to evaluate pain levels during 12h after surgery.Tramadol and diclofenac potassium suppositories were provided for pain relief if FLACC ＞ 4.The operating time(OT),anesthesia duration(AT),extubation time(ET) and awaking time(AWT) were recorded.Adverse reactions such as nausea,vomiting,headache,abdominal pain and the requirement of rescue analgesic was recorded.Results Group C had significant higher FLACC scores than group K1 and K2 during the first 30min after operation.The requirement of analgesics was also higher in the control group(P ＜ 0.05).No significant difference of FLACC scores was found between group K1 and K2.However,children in K2 group have longer awaking time (P ＜ 0.05).There was no significant difference among three groups in the FLACC score after 2 hours.Conclusion A 0.2 or 0.5mg/kg dose of ketamine given before surgery by intravenous injection provides efficient pain relief in the early period after surgery.0.2mg/kg may be preferable for its low incidence of deep sedation.

THE SURVEY ON POSTOPERATIVE HAEMORRHAGE OF PEDIATRIC ADENOTONSILLECTOMY / Шинэ санаа Шинэ нээлт

Adenotonsillectomy is most common pediatric surgical procedure. Primary and secondary hemorrhages are the major complications for all patients undergoing adenotonsillectomy. The aim of our study was to evaluate the complication rate for adenotonsillectomy in our hospital and to assess the risk of postoperative bleeding after surgery. Methods Retrospective medical record review of 748 patients who underwent adenotonsillectomy and performed at National Center for Maternal and Child Health in 2015. Patient medical records were identified and reviewed for age, sex, indications for surgery, intraoperative and perioperative interventions, and postoperative complications. Results The mean age of the study population was approximately 13 years (range, 3-16 years), with most children (76,5%) between 11 and 16 years of age. Among the patients whose records were reviewed, 728 (96,5%) did not experience any intraoperative or postoperative complications. Out of the 30 cases with postoperative bleeding after adenotonsillectomy the bleeding 22 cases were diagnosed with late operative bleeding. The main cause of the early postoperative. The rate of hemorrhage following adenotonsillectomy is low at 3,5%. In children, the risks of a hemorrhage following an adenotonsillectomy should be considered.