Revisiting the applicability of adult early post-operative nausea and vomiting risk factors for the paediatric patient: A prospective study using cotinine levels in children undergoing adenotonsillectomies.

BACKGROUND AND AIMS: Post-operative vomiting (POV) in children remains a significant clinical problem. This prospective study aims to investigate the applicability of well-established adult early post-operative nausea and vomiting (PONV) risk factors on paediatric POV after adenotonsillectomies under regulated anaesthetic conditions. METHODS: After Institutional Review Board approval, 213 children aged 3-10-year-old were enrolled. The participants had pre-operative questionnaires completed, followed protocolised anaesthetic plans and had saliva analysed for cotinine. The primary outcomes were POV as correlated with age, gender, family or personal history of PONV, motion sickness history, opioid use, surgical time, anaesthetic time and environmental tobacco smoke (ETS) exposure, as assessed by cotinine levels and questionnaire reports. Data on analgesics, antiemetics and POV incidence before post-anaesthesia care unit discharge were collected. Statistical analysis was done through multiple logistic regression. RESULTS: A total of 200 patients finalised the study. Early POV occurred in 32%. Family history of PONV (odds ratio [OR] = 5.3, P < 0.01) and motion sickness history (OR = 4.4, P = 0.02) were highly significant risk factors. Age reached borderline statistical significance (OR = 1.4, P = 0.05). None of the other factors reached statistical significance. CONCLUSION: Early POV occurs frequently in paediatric patients undergoing adenotonsillectomies. In this paediatric-aged group, the incidence of POV was affected by the family history of PONV, and history of motion sickness. Age, female gender, opioid use, surgical and anaesthetic times did not affect the incidence of POV. ETS exposure, as assessed by cotinine levels and questionnaire reports, had no protective effect on early paediatric POV.

Robotic endoscopic surgery in a porcine model of the infant neck.

Minimally invasive surgery is rapidly becoming the desired surgical standard, especially for pediatric patients. Infants and children are a particular technical challenge, however, because of the small size of target anatomical structures and the small surgical workspace. Computer-assisted robot-enhanced surgical telemanipulators may overcome these challenges by facilitating surgery in a small workspace. We studied the feasibility of performing robotic endoscopic neck surgery on a porcine model of the human infant neck. The study design was a prospective, feasibility pilot study of a small cohort for proof of concept and for a survival model. Sixteen non-survival piglets weighing 4.5-10 kg were used to develop the surgical approach and operative technique. Eight piglets aged 3-6 weeks old and weighing 4.0-9.1 kg underwent survival thyroidectomy by a cervical endoscopic approach using the Zeus surgical robot, which includes the Aesop endoscope holder and "Microwrist" microdissecting instruments. We succeeded in performing endoscopic robotic neck surgery on a piglet as small as 4 kg, in an operative pocket as small as 2 cm(3). Total incision length for all three ports was ≤23 mm. There were no major complications, no major robotic instrument malfunctions or breakages, and no procedures required conversion to open surgery. These results support the feasibility of robotic endoscopic neck surgery on a neck the size of a human infant's.

The effect of hemodialysis on voice: an acoustic analysis.

Because respiration is part of the well-coordinated process necessary for phonation, this study was conducted with the purpose of analyzing the effect of chronic hemodialysis on voice characteristics of patients with chronic renal failure. A total of 57 patients were recruited for the study, including 31 males and 26 females ranging in age from 16 to 85 years. Patients underwent evaluation of their voice directly before and after hemodialysis using the Kay Elemetric VISI Pitch (Model 330; Kay Elemetric Corporation, Lincoln Park, New Jersey). The vocal acoustic parameters studied include habitual pitch, pitch range, relative average perturbation, shimmer, noise-to-harmonic ratio, voice turbulence index, maximum phonation time, and voice energy. The data were analyzed using the paired t-test for the total sample and the nonparametric test for the female and male subgroups. The total sample analysis showed a statistically significant increase in the habitual pitch after the hemodialyis (p < 0.05), with a borderline increase in the pitch range and maximum phonation time (p < 0.10). In the female group, there was a statistically significant increase in the habitual pitch and a borderline increase in the relative average perturbation. In the male group, there was a significant increase in the habitual pitch with a borderline increase in maximum phonation time. Discussion of the after-mentioned results is presented.

Stepped-dose protocol of cidofovir therapy in recurrent respiratory papillomatosis in children.

OBJECTIVE: To evaluate a stepped-dose protocol for intralesional injection of cidofovir in children with recurrent respiratory papillomatosis (RRP). DESIGN: Prospective, nonrandomized case series. SETTING: Tertiary care children's hospital. PARTICIPANTS: Eleven children undergoing evaluation for RRP from June 1, 2000, through December 31, 2001. INTERVENTION: Intralesional injection of cidofovir was performed after microlaryngoscopy and carbon dioxide laser treatment. Patients received 4 monthly injections at a concentration of 5 mg/mL and returned 1 month after the last injection for follow-up. Patients with recurrent or recalcitrant disease then started a series of 4 monthly injections at a concentration of 10 mg/mL. OUTCOME MEASURE: Papilloma stage (0-3) documented at multiple subsites by means of serial microlaryngoscopy. We calculated a severity score by summing the scores at all affected subsites. RESULTS: The severity score decreased in each of the 11 patients during the course of therapy, from a mean +/- SD of 13.7 +/- 6.0 at enrollment to 2.1 +/- 3.4 at 1-month follow-up. Six patients experienced complete resolution (stage 0) and 4 others had mild disease (stage,

Occult supraglottic lymphatic malformation presenting as obstructive sleep apnea.

Sleep disordered breathing and obstructive sleep apnea is commonly encountered in the pediatric population. In many cases, it is the result of oropharyngeal obstruction secondary to adenoidal or adenotonsillar hypertrophy. We describe an unusual case of a child with adenoidal hypertrophy who had an occult supraglottic lymphatic malformation that manifested as obstructive sleep apnea. The management of this lesion is discussed including the use of endoscopy, carbon-dioxide laser, and the decision to avoid a tracheotomy. Occult supraglottic lymphatic malformations (LMs) are a rare cause of obstructive sleep apnea, the diagnosis of which will be missed without fiberoptic laryngeal examination. They are challenging to manage because of the airway involvement and propensity to recur.

Power-assisted adenoidectomy: total and partial resection.

OBJECTIVE: To describe the surgical technique for power-assisted adenoidectomy and review the safety and effectiveness of the procedure. STUDY DESIGN: Retrospective review. METHODS: Power-assisted adenoidectomy uses a curved microdebrider shaver blade that conforms to the nasopharynx. The action of the shaver is controlled through visualization using a laryngeal mirror. Power-assisted adenoidectomy is started high in the nasopharynx, with resection beginning in the most superior aspect of the adenoid pad and moving inferiorly to the base of the pad. The cutting edge of the microdebrider remains in view continuously. RESULTS: Between 1998 and 2001, we performed power-assisted adenoidectomy in 677 children and conducted both retrospective and prospective reviews of our experience. No instances of excess intraoperative blood loss (>150 mL), postoperative hemorrhage, velopharyngeal insufficiency, or other complication associated with adenoidectomy have occurred. CONCLUSION: We have consistently demonstrated that power-assisted adenoidectomy is precise, rapid, and safe.