ABSTRACT
OBJECTIVE: To assess the effectiveness of intravenous steroids at induction of anaesthetic to reduce post-operative nausea and vomiting and pain after adult tonsillectomy. DESIGN: Prospective, double-blind, randomized, placebo controlled trial, with ethical approval, following Consolidated Standards of Reporting Trials guidelines. SETTING: District General Hospital in Scotland, UK. PARTICIPANTS: Seventy-two adults between 16 and 70 years, American Association of Anaethetists (ASA) 1, listed for elective tonsillectomy. INTERVENTION: Single dose of either 10 mg of dexamethasone or 2 mL of saline after induction with a consistent anaesthetic technique. MAIN OUTCOME MEASURES: Patients filled in a visual analogue scale relating to pain and post-operative nausea and vomiting for the day of operation and 7 days after operation. The time to first ingestion of food and drink after operation was also noted. RESULTS: Data completion rate of 64% (46 of 72 patients enrolled). Statistically significant relative decrease (62%P = 0.001) in the incidence of post-operative nausea and vomiting was seen in those treated with dexamethasone. Statistically significant relative decrease (23%P = 0.016) in post-operative pain scores for the day of operation was seen in those treated with dexamethasone. Significant decrease (17.5%, P < 0.001) in mean pain score for seven post-operative days was seen in those treated with dexamethasone. No adverse effects were seen. CONCLUSIONS: Dexamethasone given as a single dose of 10 mg at induction of anaesthesia for adult tonsillectomy is an effective, safe and inexpensive method for reducing morbidity in adult tonsillectomy.
Subject(s)
Dexamethasone/administration & dosage , Glucocorticoids/administration & dosage , Pain, Postoperative/prevention & control , Postoperative Nausea and Vomiting/prevention & control , Tonsillectomy/adverse effects , Adolescent , Adult , Aged , Anesthetics, Intravenous , Anti-Inflammatory Agents/administration & dosage , Antiemetics/administration & dosage , Double-Blind Method , Female , Humans , Injections, Intravenous , Isoquinolines , Male , Middle Aged , Mivacurium , Neuromuscular Nondepolarizing Agents , Pain Measurement , Pain, Postoperative/etiology , Postoperative Nausea and Vomiting/etiology , Propofol , Treatment OutcomeABSTRACT
Retropharyngeal space swelling is a rare occurrence following minor head and neck trauma. Upper airway obstruction is a potentially life-threatening sequela. The authors present a case of retropharyngeal space haematoma following minor blunt head and neck trauma. Management was conservative with gradual spontaneous resolution of the haematoma. The literature is reviewed and the management and treatment principles presented.
Subject(s)
Craniocerebral Trauma/complications , Hematoma/etiology , Neck Injuries/complications , Pharyngeal Diseases/etiology , Accidental Falls , Craniocerebral Trauma/diagnostic imaging , Craniocerebral Trauma/therapy , Hematoma/diagnostic imaging , Hematoma/therapy , Humans , Male , Middle Aged , Neck Injuries/diagnostic imaging , Neck Injuries/therapy , Pharyngeal Diseases/diagnostic imaging , Pharyngeal Diseases/therapy , Radiography , Remission, Spontaneous , Treatment OutcomeABSTRACT
An adenomatous neoplasm from the middle ear was studied. Two distinct groups of cells were present. Electron microscopy suggested that one group was epithelial and the other neuroendocrine in origin. The features supported the hypothesis that such tumors arise from middle ear mucosa.
