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.

Influence of dietary and physical activity restriction on pediatric adenotonsillectomy postoperative care in Brazil: a randomized clinical trial / Influência das restrições dietéticas e de atividade física no pós-operatório da adenotonsilectomia em pacientes pediátricos no Brasil: ensaio clínico randomizado

Abstract Introduction Although culturally food and physical activity restriction are part of the routine postoperative care of many Brazilian surgeons, current evidences from other countries support no such recommendations. Objective To determine whether dietary and physical restriction effectively lead to a decrease on postoperative complications of adenotonsillectomy in children when compared to no restriction. Methods We have designed a randomized clinical trial comparing two intervention: no specific counseling on diet or activity (Group A), and restriction recommendations on diet and physical activities (Group B). Caregivers completed a questionnaire on observed pain, diet and activity patterns, and medications administered. Parameters were compared at the 3rd and at the 7th postoperative day between intervention groups. Results We have enrolled a total of 95 patients, 50 in Group A and 45 in Group B. Fourteen patients were lost to follow up. Eventually, 41 patients in group A and 40 in Group B were available for final analysis. Mean age in months (A = 79.5; SD = 33.9/B = 81.1; SD = 32.6) and sex (A = 58% male; B = 64.4% male) were equivalent between groups. Pain, evaluated through visual analog scale in the 3rd (A = 2.0; IQR 1-6/B = 4.5; IQR 2-6; p = 0.18) and in the 7th (A = 1.0; IQR 1.0-4.5/B = 2.0; IQR 1.0-4.7; p = 0.29) postoperative days, was not different between groups, as was the amount of analgesics administered. Dietary and physical activity patterns also showed no statistically significant differences between groups. Conclusion Dietary and activity restriction after adenotonsillectomy does not seem to affect patients' recovery. Such information may impact considerably on the social aspects that involve a tonsillectomy, reducing the working days lost by parents and accelerating the return of children to school.

Resumo Introdução Embora culturalmente as restrições dietéticas e de atividade física sejam parte do cuidado pós-operatório de rotina de muitos cirurgiões brasileiros, evidências atuais de outros países não apoiam tais recomendações. Objetivo Determinar se as restrições dietéticas e físicas efetivamente levam a uma diminuição das complicações pós-operatórias da adenotonsilectomia em crianças quando comparadas com cuidados sem restrição. Método Realizamos um ensaio clínico randomizado comparando duas intervenções: nenhum aconselhamento específico sobre dieta ou atividade física (Grupo A) e recomendações de restrições dietéticas e de atividades físicas (Grupo B). Os cuidadores preencheram um questionário sobre a dor, a dieta e os padrões de atividade observados, e os medicamentos administrados. Os parâmetros foram comparados no 3° e no 7° dia do pós-operatório entre os grupos de intervenção. Resultados Avaliamos 95 pacientes, 50 no Grupo A e 45 no Grupo B; 14 foram perdidos no seguimento. Subsequentemente, 41 do grupo A e 40 do grupo B estavam disponíveis para a análise final. A média de idade em meses (A = 79,5, DP = 33,9/B = 81,1, DP = 32,6) e sexo (A = 58% do sexo masculino, B = 64,4% do sexo masculino) foram equivalentes entre os grupos. A dor, avaliada através da escala visual analógica no terceiro (A = 2,0; IIQ: 1-6/B = 4,5; IIR 2-6; p = 0,18) e no sétimo (A = 1,0; IIQ 1,0-4,5/B = 2,0; IIQR 1,0-4,7; p = 0,29) dia do pós-operatório, não foi diferente entre os grupos, assim como a quantidade de analgésicos administrados. Os padrões dietéticos e de atividade física também não mostraram diferenças estatisticamente significantes entre os grupos. Conclusão A restrição dietética e de atividade física após a adenotonsilectomia não parece afetar a recuperação dos pacientes. Tal informação pode ter um impacto considerável nos aspectos sociais que envolvem uma tonsilectomia, reduzir os dias de trabalho perdidos pelos pais e acelerar o retorno das crianças à escola.

Disminución de hemorragia post adenoamigdalectomía mediante la utilzación de subgalato de bismuto / Decrease of post adenoamigdalectomy hemorrhage through the use of bismutal subgalate / Diminuição da hemorragem pós adenotonsilectomia através do uso do subgalato de bismuto

Introducción: la cirugía de amígdalas y adenoides es la más frecuentemente realizada en otorrinolaringología. La incidencia de complicaciones es baja, siendo la hemorragia la más frecuente y seria. Se estima que la incidencia de hemorragia post adenoamigdalectomia es entre 0,1 y 8,1%. Dentro de las técnicas hemostáticas se utilizan suturas, electrocauterio, radiofrecuencia, presión con packs, vasoconstrictores u otras sustancias hemostáticas. Entre estas últimas el subgalato de bismuto (activa el factor XII de la coagulación) ha sido empleado durante décadas para hemostasia de diferentes sitios quirúrgicos. El objetivo de este trabajo es determinar la eficacia de la pasta de subgalato de bismuto en la disminución de hemorragias post adenoamigdalectomías. Material y método: Trabajo retrospectivo con pacientes adultos y pediátricos intervenidos quirúrgicamente de amigdalectomía/ adenoidectomía mediante técnica de Daniels y cureta de Beckmann, a los que se dividió en dos grupos: Uno, sin la utilización de subgalato de bismuto y otro utilizando la pasta hemostática intraoperatoria. Posteriormente se comparó la incidencia de hemorragia postquirúrgica entre ambos grupos. Resultados: El primer grupo incluyó a 2.125 pacientes operados y el porcentaje de hemorragias post quirúrgicas sin la utilización del subgalato de bismuto fue de 4,56% (N=97). El otro grupo se conformó con 1.647 pacientes a los que se les aplicó la pasta de subgalato de bismuto en el lecho sangrante y el porcentaje de hemorragias post quirúrgicas descendió a 1,33% (N=22). La diferencia entre ambos grupos fue estadísticamente significativa p=0,001. Conclusiones: La pasta de subgalato de bismuto disminuye la incidencia de hemorragia post amigdalectomía.

Backgruond: tonsils and adenoid surgery are the most frequently performed in otorhinolaryngology. The incidence of complications is low, being the hemorrhage the most frequent and serious one (estimated between 0.1% and 8.1%). The hemostatic techniques used during surgery are sutures, electrocautery, radio frequency, pressure with packs, vasoconstrictors and other haemostatic substances. Between these last substances, Bismuth Subgalate (activates factor XII of coagulation) has been used during decades for hemostasis in different surgical sites. The objective is to determine the efficacy of Bismuth Subgalate paste in the reduction of postadenotonsillectomy hemorrhage. Material and method: Retrospective study including adult and pediatric patients who underwent tonsilectomy / adenoidectomy using the Daniels technique and Beckmann’s curette, which were divided into two groups: one without the use of bismuth subgalate and another using the intraoperative hemostatic paste. Subsequently, the incidence of postoperative hemorrhage between the two groups was compared. Results: The first group included 2,125 patients operated. The percentage of postoperative hemorrhages without the use of the bismuth subgalate was 4.56% (N = 97). The other group consisted of 1,647 patients in whom the Bismuth Subgalate paste was used as a hemostatic agent during surgery. The percentage of postoperative hemorrhage fell to 1.33% (N = 22). The difference between both groups was statistically significant p = 0.001. Conclutions: Bismuth subgalate paste decreases the incidence of post adenotonsillectomy hemorrhage.

Introdução: amígdalas e adenóides cirurgia é a mais realizada na otorrinolaringologia. A incidência de complicações é baixa, sendo o sangramento mais frequentes e graves. Estima-se que a incidência de hemorragia pós-adenotonsilectomia é entre 0,1 e 8,1%. Entre as técnicas hemostáticos, electrocauterização, suturas, radiofrecuecia, pacotes de pressão vasoconstritores ou outras substâncias hemostáticos são utilizados. O subgalato de bismuto ( ativa o fator de coagulação XII) tem sido usada há décadas para hemostasia de diferentes locais cirúrgicos. O objectivo é determinar a eficiência de pasta de subgalato de bismuto na redução de hemorragias pós-adenoamigdalectomia. Material e método: Estudo retrospectivo com pacientes adultos e pediátricos submetidos á cirurgia de adenoidectomia/ amigdalectomia pela técnica Daniels e cureta Beckmann, que foi dividido em dois grupos: um sem o uso de subgalato de bismuto e a outra usando pasta hemostática intraoperatória subsequentemente na incidência de hemorragia pós-cirúrgica entre os dois grupos foi comparado. Resultados: O primeiro grupo incluiu 2125 pacientes operados e a porcentagem de hemorragias pós-cirúrgico, sem o uso de subgalato de bismuto foi 4,56% (97n) o outro grupo foi formada com 1647 pacientes o qual foi aplicada uma pasta de subgalato de bismuto e a percentagem de hemorragia pós-cirurgia caiu para 1,33% (22n), a diferença entre ambos grupos foi estatisticamente significativa (p:0,001). Conclusões: a pasta de subgalato de bismuto diminui a incidencia de hemorragia pós-adenoamigdalectomia.

Pediatric adenotonsillectomy in a low resource setting: Lessons and implications

Objectives: To examine the practices related paediatric adenotonsillectomy in our setting especially in relation to blood request and transfusion, routine investigations, post-operative analgesic practice and complications. Methods: We reviewed the record of paediatric patients who had adenotonsillectomy in our facility over a 5-year period to obtain relevant information to our study. Results: There were 33 males and 19 females with mean age of 3.27 ± 2.76 years. Sinus tachycardia was found in 11(21.2 %) of the subjects and T wave anomaly in 1(1.9%) of the subject. Thirty-five (67.3%) patient had adenotonsillectomy, 13(25.0 %) adenoidectomy only and 4(7.7%) tonsillectomy only. Majority of the patients (24, 46.2%) were classified as ASA physical status I. Pre-operative blood request rate was high (49, 94.3%) though the transfusion rate was 1.9 % (1 patient). Acetaminophen combined with other analgesics was used for post-operative analgesia for most of the patients. There was significant weight gain post-operatively among patient Conclusions: Cold steel adenotonsillectomy is safe and effective in our environment. We believe that there is no justification for routine pre-operative blood request as a preconditions for surgery. We also like to suggest that post-operative pain management be streamlined taking into consideration the available analgesics in our setting

Amigdalectomía y adenoidectomía: conceptos, técnicas y recomendaciones / Tonsillectomy and adenoidectomy: concepts, techniques and recommendations

La cirugía de adenoides y amígdalas es de los procedimientos más frecuentemente realizados dentro de la especialidad, y de las operaciones más comunes en niños. Actualmente, la indicación más común es la hiperplasia asociada a trastornos del sueño, desplazando a las infecciones recurrentes como primera causa de cirugía. Debido a esto, es importante conocer los aspectos relevantes en cuanto a anatomía, fisiología, indicaciones, técnica quirúrgica y complicaciones del procedimiento. Esta revisión pretende presentar el estado del arte actual y entregar una guía inicial a los especialistas en formación, así como una actualización para quienes ya poseen experiencia dentro de la otorrinolaringología.

Surgery of the adenoids and tonsils is among the most frequently performed procedures within the speciality, and one of the commonest surgeries in children. Currently, the most frequent indication is sleep disorder-associated hyperplasia, displacing recurrent infections as the leading cause of surgery. Because of this, it is important to know relevant issues about anatomy, physiology, indications, operative technique and complications of the procedure. The intention of this review is to present the current state-of-the-art and to provide an initial guide for specialists in formation, as well as an update for experienced otorhinolaryngologists.

Complicaciones velofaríngeas de adenoamigdalectomía / Velopharyngeal complications of adenotonsillectomy

Las cirugías de adenoides y amígdalas están entre las operaciones pediátricas más frecuentemente realizadas. A pesar de ser procedimientos seguros, las complicaciones existen y deben ser conocidas y manejadas por el cirujano que las realiza. La mayoría de los casos corresponden a sangrados intra o posoperatorios, pero existen otras complicaciones que pueden manifestarse o perdurar semanas o meses después del procedimiento. Las complicaciones velofaríngeas son disfunciones del esfínter palatofaríngeo, que normalmente abre o cierra la comunicación entre la orofaringe y la nasofaringe durante la respiración, la deglución y el habla. Un déficit anatómico o funcional de este mecanismo produce el escape involuntario de aire, líquidos o alimentos hacia la nariz, situación conocida como insuficiencia velofaríngea. Por otra parte, la adherencia del velo palatino y pilares amigdalinos a la mucosa faríngea o base de la lengua producen una estenosis nasofaríngea u orofaríngea, respectivamente. Este cierre parcial o total de la nasofaringe puede manifestarse con síntomas como obstrucción nasal, rinorrea y voz hiponasal, entre otros. La comprensión de las causas que pueden llevar a estas complicaciones permitirá identificar a los pacientes en riesgo de desarrollarlas, tomar conductas quirúrgicas destinadas a prevenirlas y, en caso de presentarse, a conocer las distintas alternativas terapéuticas para manejarlas.

Surgery of the adenoids and tonsils is amongst the most frequently performed pediatric operations. Despite being safe procedures, complications do exist and must be known and managed by the surgeon who performs them. Most cases are intra or post-operative bleedings, but there are another complications that can manifest or last for weeks or even months after surgery. Velopharyngeal complications are dysfunctions of the palatopharyngeal sphincter, which normally opens or closes the communication between oropharynx and nasopharynx during breathing, deglutition and speech. An anatomical or functional deficit of this mechanism produces the involuntary escape of air, liquids or food to the nose, condition regarded as velopharyngeal insufficiency. On the other hand, the adherence of the palatine veil and tonsillar pillars to the pharyngeal mucosa or base of tongue generates a nasopharyngeal or oropharyngeal stenosis, respectively. This partial or total closure of the nasopharynx can be manifested through symptoms such as nasal obstruction, rhinorrhea and hyponasality, among others. Understanding the causes that may lead to this complications will allow to identify patients in risk of developing them, taking surgical measures destined to prevent them and, in case of developing such complications, to know the different therapeutic alternatives for their management.

Risk factors for respiratory complications after adenotonsillectomy in children with obstructive sleep apnea / Fatores de risco para complicações respiratórias após adenotonsilectomia em crianças com apneia obstrutiva do sono

Objective: To identify risk factors for respiratory complications after adenotonsillectomy in children ≤ 12 years of age with obstructive sleep apnea who were referred to the pediatric ICU (PICU). Methods: A cross-sectional historical cohort study analyzing 53 children after adenotonsillectomy who met predetermined criteria for PICU referral in a tertiary level teaching hospital. The Student's t-test, Mann-Whitney test, and chi-square test were used to identify risk factors. Results: Of the 805 children undergoing adenotonsillectomy between January of 2006 and December of 2012 in the teaching hospital, 53 were referred to the PICU. Twenty-one children (2.6% of all those undergoing adenotonsillectomy and 39.6% of those who were referred to the PICU) had respiratory complications. Of those 21, 12 were male. The mean age was 5.3 ± 2.6 years. A high apnea-hypopnea index (AHI; p = 0.0269), a high oxygen desaturation index (ODI; p = 0.0082), a low SpO2 nadir (p = 0.0055), prolonged orotracheal intubation (p = 0.0011), and rhinitis (p = 0.0426) were found to be independent predictors of respiratory complications. Some of the complications observed were minor (SpO2 90-80%), whereas others were major (SpO2 ≤ 80%, laryngospasm, bronchospasm, acute pulmonary edema, pneumonia, and apnea). Conclusions: Among children up to 12 years of age with OSA, those who have a high AHI, a high ODI, a low SpO2 nadir, or rhinitis are more likely to develop respiratory complications after adenotonsillectomy than are those without such characteristics. .

Objetivo: Identificar fatores de risco para complicações respiratórias após adenotonsilectomia em crianças ≤ 12 anos com apneia obstrutiva do sono encaminhadas à UTI pediátrica (UTIP). Métodos: Estudo de coorte histórica com corte transversal que analisou 53 crianças após adenotonsilectomia que preencheram os critérios pré-estabelecidos para encaminhamento à UTIP em um hospital escola de nível terciário. Foram utilizados o teste t de Student, o teste de Mann-Whitney e o teste do qui-quadrado para identificar os fatores de risco. Resultados: Das 805 crianças submetidas à adenotonsilectomia entre janeiro de 2006 e dezembro de 2012 no hospital escola, 53 foram encaminhadas à UTIP. Vinte e uma crianças (2,6% do total de submetidas à adenotonsilectomia e 39,6% das que foram encaminhadas à UTIP) apresentaram complicações respiratórias, sendo 12 do gênero masculino e a idade média de 5,3 ± 2,6 anos. Maior índice de apneia-hipopneia (IAH; p = 0,0269), maior índice de dessaturação de oxigênio (IDO; p = 0,0082), baixo nadir da SpO2 (p = 0,0055), maior tempo de intubação orotraqueal (p = 0,0011) e rinopatia (p = 0,0426) foram preditores independentes de complicações respiratórias. Foram observadas complicações respiratórias menores (SpO2 entre 90-80%) e maiores (SpO2 ≤ 80%, laringoespasmos, broncoespasmos, edema agudo de pulmão, pneumonia e apneia). Conclusões: Em crianças de até 12 anos e com apneia obstrutiva do sono, aquelas que têm maior IAH, maior IDO, menor nadir da SpO2 e/ou rinopatia são mais predispostas a desenvolver complicações respiratórias após adenotonsilectomia do que aquelas sem essas características. .

Cuestionario de sangrado preoperatorio en pacientes sometidos a amigdalectomía y/o adenoidectomía / Preoperative survey of bleeding in patients undergoing tonsillectomy and or adenoidectomy

Introducción: Se reporta entre 1 por ciento y 6 por ciento de hemorragia posamigdalectomía y/o adenoidectomía. En la literatura se discute la real utilidad de los exámenes de hemostasia de rutina. Cuestionarios de sangrado estandarizados podrían definir a quién realizar un estudio de coagulación para predecir sangrados posamigdalectomía y/o adenoidectomía. Objetivo: Determinar la utilidad de un cuestionario preoperatorio para evaluar historia de sangrado y exámenes de coagulación rutinarios, para predecir sangrados asociados a amigdalectomía y/o adenoidectomía. Material y método: Se realizó un estudio prospectivo de cohorte, en el Servicio de Otorrinolaringología, Hospital Barros Luco. Se incluyeron pacientes sometidos a amigdalectomía y/o adenoidectomía, con cuestionario a menores de 18 años, entre enero de 2008 y junio de 2010. Se usó Chi cuadrado, Fisher, t de student según correspondiera para el análisis de los grupos. Se consideró estadísticamente significativo p <0,05. Resultados: Se revisaron 951 fichas de pacientes operados en el período de estudio, de un total de 1.288 cirugías (73,8(0) por ciento). Se excluyeron 65 por información incompleta y 272 sin cuestionario. Elpromedio (DE) de edad fue 7,70 +/-3,5 años (Rango: 1 -18 años). El 54 por ciento de los pacientes fue de sexo masculino. La frecuencia de sangrado fue 2,6 por ciento. La razón de proporciones (OR) para edad fue 1,11 (IC 95 por ciento 1,01-1,23); para amigdalitis crónica fue 2,56 (IC 95 por ciento 1,15-5,69). Los exámenes presentaron una sensibilidad de 4 por ciento y un valor de predicción positivo de 3 por ciento. El cuestionario de sangrado preoperatorio presentó una sensibilidad de 24 por ciento y un valor de predicción positivo de 3 por ciento. Discusión: El bajo valor de predicción positivo del cuestionario y los exámenes (3 por ciento) se asoció a la baja prevalencia de sangrado y otros factores involucrados en el sangrado posoperatorio. . .

Introduction: It is reported between 1percent and 6 percent of post-tonsillectomy hemorrhage and / or adenoidectomy. The literature discusses the real usefulness of routine hemostasis tests. Standardized questionnaires bleeding could define who make a study of post-tonsillectomy bleeding bleeding to predict and/or adenoidectomy. Aim: To determine the usefulness of a preoperative questionnaire to assess history of bleeding and routine coagulation tests to predict bleeding associated with tonsillectomy and/or adenoidectomy. Material and method: We performed a prospective cohort study in the Department of Otolaryngology, Hospital Barros Luco. We included patients undergoing tonsillectomy and / or adenoidectomy, with guest under 18 years between January 2008 and June 2010. We used chisquare, Fisher, Student t test as appropriate for the analysis of the groups. Statistical significance was p <0.05. Results: We reviewed 951 records of patients operated in the study period, a total of 1288 surgeries (73.8 percent). 65 were excluded due to incomplete information and 272 without questionnaire. The mean (SD) age was 7.70 + 3.5years (range: 1 to 18 years). 54 percent of patients were male. The frequency of bleeding was 2.6 percent. The ratio of ratios (OR) for age was 1.11 (95 percent C11.01 to 1.23) for chronic tonsillitis was 2.56 (95 percent C11.15 to 5.69). The tests showed a sensitivity of 4 percent and positive predictive value of 3 percent. The preoperative bleeding questionnaire had a sensitivity of 24 percent and positive predictive value of 3 percent. Discussion: The low positive predictive value of the questionnaire and examinations (3 percent) was associated with low prevalence of bleeding and other factors involved in postoperative bleeding. The questionnaire had a greaterability to detectpostoperative bleeding (24 percent). The use of the questionnaire represents a reliable tool that tests, but less expensive and less traumatic...

[Dexamethasone plus metoclopramide for prevention of postoperative nausea and vomiting in patient undergoing adenotonsilectomy -a comparison]

Adenstonsilectomy is the most prevalent procedure in Earand nose and throat specialty, and unfortunately the main reason for delaying discharging such patients is nausea and vomiting. Meanwhile, the most prevalent side effect of this surgery is recovery from anesthesia. Using medicines with minimum complication and price which can be effective in controlling this problem and reducing side effects of patient's discharge and relevant problems, is a good option. In this study, 60 persons were candidates for Adenstonsilectomy, which have been introduced to operation room of Loghman Hospital. They have studied for a period of 6 months. These patients were divided in 2 groups each with 3 cases. In one group Dexamethasone and Metoclopramide was used and in second one Ondansetrone with sterile water at the same dosage. Immediately they received Induction, and stomach wre evacuated by NG tube. For preserving the anesthesia they received propofol 150-200 micro g/kg with 50% [O2 + N2O], then they have been supervised between 0-3, 3-12, 12-24 hours after surgery for nausea and vomiting in recovery room and at E.N.T. Ward. No statistically significant difference in nausea and vomiting had been found in these two studied goups between 0-3, 3-12, and 12-24 hours after surgery. Our study indicated that the compound Dexamethasoen and metoclopramide can be effective, the same as ondanstron, in controlling nausea and vomiting after surgery of Adenstonsilectomy during different hours, and there was no meaningful difference between these two drugs with Ondansetrone, in controlling nausea and vomiting after surgery, and in our study; Ondansetrone has no preference in using Dexamethasone and Metoclopramide simultaneously

Anaesthetic risks in children with obstructive sleep apnea syndrome undergoing adenotonsillectomy

To determine the frequency of anaesthetic risks in children having Obstructive Sleep Apnea Syndrome [OSAS], undergoing adenotonsillectomy. A case-control study. Department of Anaesthesiology, Armed Forces Hospital, Najran, Saudi Arabia from November 2006 to January 2008. The study was carried out in 60 children scheduled to undergo adenotonsillectomy and divided into two equal groups of 30 each. Group-1 had obstructive sleep apnoea syndrome and group-2 had children without it. Both groups were given a standard general anaesthesia and frequency and rate of complications and medical interventions taken in such children were studied. P-value and odds ratio were determined. The age ranged from 3 to 10 years. The frequency of difficult intubation was higher in the group-1 than in the control group [16.6 vs. 3.3%, odds ratio 5.8]. At the time of induction of anaesthesia desaturation was higher in group-1 [33.3 vs. 6.6%, p=0.021, odds ratio 7]. At the time of extubation, desaturation was significantly higher in group-1 [43.3 vs. 6.6%, p=0.002, odds ratio 10.70]. The complications at extubation, for example cough, laryngospasm and postoperative nausea and vomiting were higher in group-1 but not statistically significant. In the postanaesthesia care unit, the frequency of complications and medical interventions were also higher in group-1. More patients of group-1 required oxygen [63.3 vs. 10%, p < 0.001, odds ratio 15.54] and insertion of an oropharyngeal airway [20% vs. nil, p=0.023] respectively. Children with OSAS, operated for adenotonsillectomy, are at significant risk of certain life-threatening perioperative anaesthetic complications. These results may be used as a guideline for safe and successful anaesthetic management of these children

Combination effect of low dose fentanyl and propofol on emergence agitation in children following sevoflurane anesthesia

To investigate the combination effect of low dose fentanyl and subhypnotic dose of propofol on emergence agitation in children receiving sevoflurane for adenotonsillectomy procedure. After ethical approval, a prospective, randomized, clinical study was performed in Saad Specialist Hospital, Al-Khobar, Kingdom of Saudi Arabia in 2007-2008. One hundred and twenty children in physical status of I according to the American Society of Anesthesiologists, aged 2-6 years, scheduled for adentonsillectomy under general anesthesia were allocated into 3 groups randomly. Anesthesia was induced and maintained by sevoflurane in all groups. Children received 0.1 ml.kg-1 normal saline at the end of surgery in group C [n=40], 1.5 mcg.kg-1 fentanyl during induction, and 0.1 ml.kg-1 normal saline at the end of surgery in group F [n=40], and 1.5 mcg.kg-1 fentanyl during induction and 1 mg.kg-1 propofol at the end of surgery in group FP [n=40]. Postoperative agitation was recorded, if any, for the first postoperative hour. Three groups were comparable with regard to demographic data. Twenty-one patients [53%] in the control group, 14 patients [35%] in group F and 7 [18%] patients in group FP experienced postoperative agitation. The combination of low dose fentanyl before surgery and propofol at the end of surgery decreases the incidence and level of emergence agitation in children after adenotonsillectomy procedure under sevoflurane anesthesia

Mutirão de cirurgias de adenotonsilectomias: uma solução viável? / Adeno-tonsillectomy surgery in a joint aid effort: a feasible solution ?

Os hospitais públicos sofrem com a demanda reprimida de indicações de cirurgias de adenoidectomia e/ou tonsilectomia, fazendo com que haja uma fila de espera crescente. O otorrinolaringologista se acostumou com as filas de espera, talvez por entender que este é um problema exclusivo do estado. Achamos de fundamental importância a realização de mutirões dessas cirurgias. OBJETIVOS: Padronizar a organização de mutirões, sua eficácia e viabilidade para os hospitais públicos e comparar a hemorragia pós-operatória nos mutirões e em cirurgias de rotina. MATERIAL E MÉTODOS: Estudo clínico-prospectivo tipo coorte. Foram realizados mutirões de adenotonsilectomias no período de setembro de 2004 a junho de 2006, no Hospital Estadual de Diadema, analisando-se a equipe multiprofissional envolvida e comparando a complicação hemorragia no pós-operatório com um grupo controle de cirurgias realizadas na rotina. RESULTADOS: Foram realizados 22 mutirões no período (339 cirurgias), uma média de 15,4 cirurgias por mutirão. O índice de hemorragia pós-operatória que necessitou de revisão foi de 1,48 por cento (5/339), não diferindo estatisticamente do grupo controle, 1,37 por cento (5/364). CONCLUSÃO: Conseguimos padronizar a realização de mutirões de cirurgias de adenotonsilectomias, dentro dos parâmetros que consideramos mais seguros, diminuindo a fila de espera das cirurgias. O índice de hemorragia no pós-operatório entre as cirurgias nos mutirões e na rotina não mostrou diferença estatisticamente significante.

Public hospitals in Brazil are under capacity for adenotonsillectomies, resulting in a growing waiting line. Otolaryngologists are used to these lines, since they understand that this problem is under govern responsibility. For this reason we believe that joint aid efforts to carry out adenotonsillectomies are justified. AIM: To standardize the organization of adenotonsillectomies in joint aid efforts, its effectiveness and feasibility for public hospitals, and to compare the incidence of post-operative hemorrhage in joint aid effort surgery with that of regular surgeriy. METHODS: A clinical case-control prospective study of adenotonsillectomies done in joint aid efforts was done from September 2004 to June 2006 at the Diadema State Hospital. An analysis was made of the multiprofessional staff involved in this process, and a comparison was made of the incidence of hemorrhage in joint aid efforts and after regular surgery. RESULTS: 22 joint aid effort events for adenotonsillectomies were done during the period mentioned above (339 surgeries), an average 15.4 surgeries per event. The rate of postoperative hemorrhage requiring surgical revision was 1.48 percent(5/339), which did not differ statistically from the case-control group (1.37 percent - 5/364). CONCLUSION: We were able to standardize the results of adenotonsillectomies done in a joint aid effort to the parameters that are considered as safe. This may reduce the waiting line for this procedure. The difference in the incidence of postoperative hemorrhage in the joint aid effort and regular surgery was not statistically significant.

Post-tonsillectomy and adenotonsillectomy morbidity and complications at district headquarter hospital daggar

Tonsillectomy or adenotonsillectolny is one of the commonly performed operations in ENT practice. Morbidity and complications associated with tonsillectomy and adenotonsillectomy include severe otalgia, pyrexia, odynophagia and haemorrhage. A prospective study was undertaken from April 1996 to April 2001 to report the experience regarding postoperative morbidity/complications in tonsillectomy and/or adenotonsillectomy. A total of 1500 patients undergoing tonsillectomy or adenotonsillectomy for chronic/recurrent tonsillitis or adenotonsillar hypertrophy were included. These patients received antibiotic in the form of amoxycillin and clavulanic acid and non-salicylate analgesics for 7 days postoperatively. 100 patients were lost to follow up. Seventy% of patients were female and thirty% males with maximum number of patients between the age of 11-22 years. Postoperative complications developed in 25 out of 1400 patients, 14 of them developed post-operative bleeding and 9 developed postoperative infection. Conclusions: It was found that postoperative morbidity / complications were less in this study with regard to secondary haemorrhage, operative site infection, intensity and duration of postoperative pain, postoperative pyrexia and time for return to normal activities

Tubos timpánicos, adenoidectomía y amigdalectomía. ¿patrones imitativos en una sociedad de consumo terapeútico? / Tympanic ventilation tubes, adenoidectomy and tonsillectomy. an imitative pattern in a theraphy consumer society?

El trabajo analiza las indicaciones y las limitantes terapéuticas de tres procedimientos quirúrgicos comunes en la infancia, la aplicación de tubos de ventilalción timpánica, la adenoidectomía, y la amigdalectomía. Analiza la posibilidad de que se practiquen por razones no médicas y concluye estableciendo las indicaciones terapéuticas en cada procedimiento. Considera que no es probable que ninguna de esas cirugías se practiquen por presiones de la familia ni por conceptos rituales. Las veces que son innecesarias es simplemente por mala indicación, y el responsable es el médico

Abscesso retrofaríngeo pós adenoidectomia / Retropharyngeal abscess after adenoidectomy

Neste trabalho descreveremos um caso de abscesso retrofaríngeo associado à subluxaçäo atlanto-axial pós adenoidectomia. O paciente apresentou evoluçäo favorável com a instituiçäo de antibioticoterapia sistêmica e drenagem cirúrgica. Este tipo de complicaçäo ocorrida após adenoidectomia é bastante rara, devendo o otorrinolaringologista estar atento à mesma. As principais causas de abscesso retrofaríngeo encontradas na bibliografia form: trauma e ingestäo de corpo estranho. As principais complicaçöes pós adenoidectomia encontradas incluiam sangramento, reaçöes referentes ao agente anestésico, hipernasalidade, otalgia, cervicalgia e estenose nasofaríngea.

Prevençäo da insuficiência velopalatina em crianças com indicaçäo de adenoidectomia / Prevention of velopharingeal insufficiency in children with indication of adenoidectomy

Crianças com rinolalia säo encaminhadas com freqüência para adenoidectomia. Os autores alertam para os riscos do agravamento ou surgimento da insuficiência velopalatina, apresentando dois casos ilustrativos. Encontraram defeito de fechamento do palato em um e insuficiência compensada pelo volume de adenóides em outro. Säo apresentados e comentados os sinais físicos em nível de consultório e eventuais exames necessários para os casos de suspeita clínica, nos quais a adenoidectomia é contra-indicada