Post-tonsillectomy Hemorrhage in Patients Receiving Ketorolac Analgesic.

Background Ketorolac, the non-steroidal anti-inflammatory drug, is thought to have less sedation as well as postoperative nausea and vomiting in comparison to opioids, but with higher risk of post-tonsillectomy hemorrhage as reported in some of the literatures. There is no consensus till date in the use of ketorolac in the management of pain following tonsil and adenoid related surgeries. Objective To find out the incidence of hemorrhage following tonsil and adenoid related surgeries in patients receiving ketorolac in postoperative period. Method This is a retrospective chart review of patients undergoing tonsil and adenoid related surgeries who had received ketorolac during April, 2013 to May, 2019 at department of ENT-HNS, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. Post-tonsillectomy hemorrhage rate was calculated in pediatric and adult patients. Result During the study period, 103 patients (male - 50 and female - 53) received ketorolac in postoperative period. Tonsillectomy and adenotonsillectomy were performed in 71and 32 patients respectively. Forty-five patients were < 18 years whereas 58 were ≥ 18 years. Most common indication for surgery was recurrent tonsillitis (66/103) followed by adenotonsillar hypertrophy (31/103). Post-tonsillectomy hemorrhage was observed in 15 patients; among them, four out 45 were < 18 years and 11 out of 58 ≥ 18 years. All five patients out of 15, who required surgical intervention for post-tonsillectomy hemorrhage, were ≥ 18 years and were operated for recurrent tonsillitis. Rest of the patients (10/15) were managed conservatively. None of the patients required blood transfusion. Conclusion Ketorolac is not associated with increased risk of post-tonsillectomy hemorrhage in children and can safely be administered. Whereas in adults, recurrent tonsillitis being the most common indication for tonsillectomy, it should be used cautiously.

Declining fertility in Nepal.

PIP: This article relies on data from the 1991 Nepal Fertility, Family Planning, and Health Survey (NFFPHS) and the 1996 Nepal Living Standards Survey (NLSS) to assess trends in fertility in Nepal. The NFFPHS shows heaping at ages 5, 8, 10, and 12 years and a larger proportion of infants. The NLSS shows a different pattern of misreporting of youth and a stronger but similar pattern of age heaping as the NFFPHS for adults. Children ever born by maternal age indicates a degree of completeness and the deletion by older women of deceased children and married children living outside the household. Findings suggest less complete reporting in the NLSS. Age-specific fertility rates are calculated based on birth histories (BH) and the own-children (OC) method based on life tables. Findings indicate that BH and OC estimates of the cumulative fertility rate (CFR) derived from the NLSS and the NFFPHS were comparable for estimating trends in the total fertility rate (TFR). The trends from the two data sets overlapped fairly well during 1983-89. Fertility trends by single years of age showed considerably annual fluctuations due to age misreporting. The CFR and TFR for aggregated time periods showed little or no decline for the earlier 5-year period, a steeper decline in the second period, and variations in trends by data set for the third period from 1983 to 1989. One curve showed no decline and the other showed fertility decline. Fitting a straight line to the trend for 1977-91 shows that CFR declined by 1.61 children from 5.29 children in 1977 to 3.68 children in 1991. TFR declined by 1.90 children from 6.68 children in 1977 to 4.78 children in 1991. The author cautions that the point of fertility decline was not determined exactly, but data suggest that decline occurred around 1980, and the rate was fast thereafter. TFR declined by 2.70 children in urban areas and 1.83 children in rural areas.^ieng