Adenoidectomy In Children Research Articles

Examination under anaesthesia of post-nasal space +/- adenoidectomy in children

Examination under anaesthesia of post-nasal space +/- adenoidectomy in children

Balloon Catheter Sinuplasty and Adenoidectomy in Children With Chronic Rhinosinusitis

Balloon Catheter Sinuplasty and Adenoidectomy in Children With Chronic Rhinosinusitis

Relative nasopharyngeal patency index as possible objective indication for adenoidectomy in children with orthodontic problems

Objectives Although the harmful influence of nasopharyngeal obstruction on the facial skeleton has been demonstrated, clear criteria to qualify children with adenoid hypertrophy and malocclusion for adenoidectomy have not been established yet. Methods Retrospective analysis of 148 patients qualified for orthodontic treatment (77 females and 71 males) at the age of 9–11 years (the average age was 10 years and 3 months). X-ray images performed with the use of a cephalostat were scanned and submitted for cephalometric assessment. The study investigated the correlation between standard cephalometric parameters and the value of relative nasopharyngeal flow defined as the ratio of the nasopharyngeal flow to the dimension of the entire nasopharynx. In statistics Bartlett's test, Tukey's test and Pearson's correlation coefficients were used. Results The value of relative nasopharyngeal lumen ranged from 0.0943 to 0.5532 with no significant differences between genders. The subjects were divided into decile groups for investigating the correlation with cephalometric parameters. The study demonstrated statistically significant negative correlations between relative nasopharyngeal flow and the following parameters: the angle between lines NA and NB (ANB), the angle between lines SN and ML (SN/ML), the posterior/anterior facial height ratio (Post.Fac.H./Ant.Fac.H.), the difference between the maxillary and mandibular length (difference maxillary/mandibular), the mandibular length (Co-Gn) and the lower anterior facial height (Sn-Me). The correlations generally referred to middle deciles: from the 40th to 80th decile. An apparent lack of significant correlations in patients located below the 40th decile, which corresponded to the value of relative nasopharyngeal flow up to 18%, may indicate, that this value constitutes a threshold and further decreasing it exceeds adaptive capabilities of the body. Conclusions Relative nasopharyngeal flow below 38% should constitute an indication for adenoidectomy, due to the exceeded adaptive capabilities of the body.

Balloon Catheter Sinuplasty and Adenoidectomy in Children with Chronic Rhinosinusitis

Adenoidectomy is the first step in the surgical management of children with chronic rhinosinusitis (CRS). Adenoidectomy, however, is only effective in half of these children. Although endoscopic sinus surgery is effective for CRS, there is concern for facial growth retardation and major complications. We propose that balloon catheter sinuplasty (BCS) is a minimally invasive, effective procedure in the treatment of pediatric CRS. We undertook a nonrandomized, controlled, prospective review of children with failed medical management of CRS who underwent BCS or adenoidectomy. Outcomes were assessed at 1 year of follow-up and were based on SN-5 scores and the need for revision surgery. Forty-nine children who satisfied the inclusion criteria were reviewed. Thirty of the children had BCS. The age range was 4 to 11 years (mean, 7.7 years), and the mean computed tomography score (Lund-Mackay system) was 7.5. Twenty-four of the 30 patients (80%) who underwent BCS showed improvement of their symptoms after 12 months of follow-up, compared with 10 of the 19 patients (52.6%) who underwent adenoidectomy (p < 0.05). A multivariate analysis using logistic regression analysis with age, sex, asthma, and computed tomography score as covariables showed that BCS was also more effective than adenoidectomy in older children. None of the other variables showed statistical significance. Balloon catheter sinuplasty offers a procedure that is more effective than adenoidectomy and less invasive than endoscopic sinus surgery in the treatment of pediatric CRS.

A cost-effectiveness analysis of coagulation testing prior to tonsillectomy and adenoidectomy in children

The American Society of Pediatric Otolaryngology recommends pre-operative coagulation testing only when indicated by history or physical exam. Nevertheless, many surgeons test all children scheduled for tonsillectomy and/or adenoidectomy (T&A). Studies of pre-operative screening have had conflicting results. A decision analysis model was constructed to address the costs and health outcome states of pre-operative screening strategies in children. A 14-day Markov model evaluated three strategies: (1) test all children for coagulation disorders; (2) test only those children with a pertinent history; and (3) perform no pre-operative testing. A literature search and a review of national databases estimated probabilities, costs, and utility data. Parameters then were varied widely in sensitivity analyses. Using a societal perspective and a cycle length of 1 day, we compared the strategies based on total costs and quality-adjusted life years (QALYs). Total costs for the strategies were $3,200 for testing all children, $3,083 for testing only those with a history finding, and $3,077 for not testing. Total utilities were 0.02579, 0.02654, and 0.02659 QALYs, respectively. Cost-effectiveness ratios were most sensitive to variation in the cost of post-operative care and the probability of post-operative bleeding. The strategy of not testing was dominant in all sensitivity analyses. Our results demonstrate that not performing preoperative testing is the most cost-effective strategy. This was persistent in sensitivity analyses, indicating that the model was robust. These data may be helpful to institutions and organizations to formulate policies regarding pre-operative coagulation for children without previous diagnoses of bleeding disorders.

Adenoidectomy for recurrent or chronic nasal symptoms in children

Adenoidectomy, surgical removal of the adenoids, is a common ENT operation worldwide in children with recurrent or chronic nasal symptoms. A systematic review on the effectiveness of adenoidectomy in this specific group has not previously been performed. To assess the effectiveness of adenoidectomy versus non-surgical management in children with recurrent or chronic nasal symptoms. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 30 March 2009. Randomised controlled trials comparing adenoidectomy, with or without tympanostomy tubes, versus non-surgical management or tympanostomy tubes alone in children with recurrent or chronic nasal symptoms. The primary outcome studied was the number of episodes, days per episode and per year with nasal symptoms and the proportion of children with recurrent episodes of nasal symptoms. Secondary outcomes were mean number of episodes, mean number of days per episode and per year, and proportion of children with nasal obstruction alone. Two authors assessed trial quality and extracted data independently. Only one study included children scheduled for adenoidectomy because of recurrent or chronic nasal symptoms or middle ear disease. In this study no beneficial effect of adenoidectomy was found. The numbers in this study were, however, small (n = 76) and the quality of the study was moderate. The outcome was improvement in episodes of common colds. The risk differences were non-significant, being 2% (95% CI -18% to 22%) and -11% (95% CI -28% to 7%) after 12 and 24 months, respectively.A second study included children with recurrent acute otitis media (n = 180). As otitis media is known to be associated with nasal symptoms, the number of days with rhinitis was studied as a secondary outcome measure. The risk difference was non-significant, being -4 days (95% CI -13 to 7 days). Current evidence regarding the effect of adenoidectomy on recurrent or chronic nasal symptoms or nasal obstruction alone is sparse, inconclusive and has a significant risk of bias.High quality trials assessing the effectiveness of adenoidectomy in children with recurrent or chronic nasal symptoms should be initiated.

Adenoidectomy for otitis media in children

Adenoidectomy, surgical removal of the adenoids, is a common ENT operation worldwide in children with otitis media. A systematic review on the effectiveness of adenoidectomy in this specific group has not previously been performed. To assess the effectiveness of adenoidectomy versus non-surgical management or tympanostomy tubes in children with otitis media. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 30 March 2009. Randomised controlled trials comparing adenoidectomy, with or without tympanostomy tubes, versus non-surgical management or tympanostomy tubes only in children with otitis media. The primary outcome studied was the proportion of time with otitis media with effusion (OME). Secondary outcomes were mean number of episodes, mean number of days per episode and per year, and proportion of children with either acute otitis media (AOM) or otitis media with effusion (OME), as well as mean hearing level. Tertiary outcome measures included atrophy of the tympanic membrane, tympanosclerosis, retraction of the pars tensa and pars flaccid and cholesteatoma. Two authors assessed trial quality and extracted data independently. Fourteen randomised controlled trials (2712 children) studying the effectiveness of adenoidectomy in children with otitis media were evaluated. Most of these trials were too heterogeneous to pool in a meta-analysis. Loss to follow up varied from 0% to 63% after two years.Adenoidectomy in combination with a unilateral tympanostomy tube has a beneficial effect on the resolution of OME (risk difference (RD) 22% (95% CI 12% to 32%) and 29% (95% CI 19% to 39%) for the non-operated ear at six and 12 months, respectively (n = 3 trials)) and a very small (< 5 dB) effect on hearing, compared to a unilateral tympanostomy tube only. The results of studies of adenoidectomy with or without myringotomy versus non-surgical treatment or myringotomy only, and those of adenoidectomy in combination with bilateral tympanostomy tubes versus bilateral tympanostomy tubes only, also showed a small beneficial effect of adenoidectomy on the resolution of the effusion. The latter results could not be pooled due to large heterogeneity of the trials.Regarding AOM, the results of none of the trials including this outcome indicate a significant beneficial effect of adenoidectomy. The trials were too heterogeneous to pool in a meta-analysis.The effects of adenoidectomy on changes of the tympanic membrane or cholesteatoma have not been studied. Our review shows a significant benefit of adenoidectomy as far as the resolution of middle ear effusion in children with OME is concerned. However, the benefit to hearing is small and the effects on changes in the tympanic membrane are unknown. The risks of operating should be weighed against these potential benefits.The absence of a significant benefit of adenoidectomy on AOM suggests that routine surgery for this indication is not warranted.

Comparison among different anesthesia methods for tonsillectomy and adenoidectomy in children

Objective To compare the advantages and the disadvantnges among the different anesthesia methods in children for tortsillectomy and adenoidectomy.Methods 90 cases with ASA Ⅰscheduled for tonsillectomy and adenoidectomy.The children were. randomly divided into three, groups.Patients in group Ⅰ received Fentanil combined with Isoflurane general anesthesia;patients in group Ⅱ received Remifentanil combined with Propofol general anesthesia and patients in group Ⅲ received Remifentanil combined with Propofol and Tramadol general anesthesia.Observing SBP、DBP、HR、SPO2 at the time that before inducing, inserting tube, adenoidectomy, pulling out tube, the recovery time, incidental of side effect, and post operative pain score VAS.Results Tthere were no significant difference on the SBP、DBP、HR、SPO2 at the time before induction, ntubation.After adenoidectomy in these three groups (P > 0.05). SBP、DBP、HR in group Ⅰ were larger than in group Ⅱ，Ⅲ (P < 0.05) at the time after extuhation. The recovery time of anesthesia was significantly longer in the group Ⅰ than in the group Ⅱ,Ⅲ incidena of the upper respiratory tract obstruction,nausea,vomiting, and restless more were higher in the group Ⅰ than in the group Ⅱ,Ⅲ (P < 0.05).Post operative pain score was significantly higher in the group Ⅱ than in the group Ⅰ and Ⅲ(P < 0.05). Conclusions remifentanil combined with Propofol and Pramadol general anesthesia is a effective anes-thesia methods for tonsillectomy and adenoidectomy in children,and it can wake induce stably,recover fast, and completely. Key words: Anesthesia methods; Tonsillectomy and adenoidectomy; Children

Re: Tonsillectomy and adenoidectomy in children with sleep‐related breathing disorders: consensus statement of a UK multidisciplinary working party

Clinical OtolaryngologyVolume 34, Issue 5 p. 493-493 Re: Tonsillectomy and adenoidectomy in children with sleep-related breathing disorders: consensus statement of a UK multidisciplinary working party H. Al-reefy, H. Al-reefy East Kent Hospitals NHS trust, Kent, UK.E-mail: [email protected]Search for more papers by this authorJ. Fleming, J. Fleming East Kent Hospitals NHS trust, Kent, UK.E-mail: [email protected]Search for more papers by this authorD. Mitchell, D. Mitchell East Kent Hospitals NHS trust, Kent, UK.E-mail: [email protected]Search for more papers by this author H. Al-reefy, H. Al-reefy East Kent Hospitals NHS trust, Kent, UK.E-mail: [email protected]Search for more papers by this authorJ. Fleming, J. Fleming East Kent Hospitals NHS trust, Kent, UK.E-mail: [email protected]Search for more papers by this authorD. Mitchell, D. Mitchell East Kent Hospitals NHS trust, Kent, UK.E-mail: [email protected]Search for more papers by this author First published: 24 September 2009 https://doi.org/10.1111/j.1749-4486.2009.01999.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume34, Issue5October 2009Pages 493-493 RelatedInformation

Partial adenoidectomy by suction diathermy in children with cleft palate, to avoid velopharyngeal insufficiency

Objectives Adenoidectomy is indicated for the relief of paediatric nasal obstruction, sleep-disordered breathing and otitis media with effusion (OME). Velopharyngeal insufficiency (VPI) is a rare complication. The main risk factor is the presence of pre-existing velopharyngeal closure-impaired mechanisms, including submucosal or overt cleft palate. Despite possible benefits, adenoidectomy is frequently withheld in such children to avoid VPI. This study aims to demonstrate the efficacy and safety of partial adenoidectomy using suction diathermy in children who previously underwent overt cleft palate repair during infancy, to allow selective resection of tissue and symptom resolution without producing VPI. Methods Since 1994, 18 patients with previously corrected overt cleft palate have undergone partial adenoidectomy at this centre, for the treatment of nasal obstruction or sleep-disordered breathing, with or without OME. Three had existing VPI following their cleft correction surgery. Selective resection of the adenoid was performed transorally under indirect vision, using a malleable suction coagulator. This allowed exposure of the posterior choanae, leaving the remaining adenoid bulk intact. Results Patients were followed up at 4 weeks, and subsequently at regular intervals (total follow up 30–180 months, median 92 months), including perceptual speech assessment in all cases. All demonstrated symptomatic improvement with respect to the original indications for surgery. None developed worsening hypernasal speech or other features of VPI, and there were no cases of symptomatic adenoidal re-growth. Conclusions Partial adenoidectomy, employing a variety of methods, has been used successfully in children with submucosal cleft palate. This study demonstrates the safe and effective use of suction diathermy to enable partial adenoidectomy in children who have previously undergone surgical correction of overt cleft palate, allowing symptom resolution without producing VPI.

The effect of adenoidectomy on right ventricular performance in children

Objective Several studies have shown a reduction in pulmonary artery pressure (PAP) after adenoidectomy in children suffering form upper airway obstruction caused by adenoid hypertrophy (AH). However, it is not clear whether this would be significantly reflected on right ventricle output (RVO). Methods Our aim was to determine if there were any detectable changes in RV performance parameters after adenoidectomy in children with AH. Thirty children with AH (female/male: 11/19) aged between 2.5 and 12 years (median: five years) were included in this study. Adenoidectomy was performed under sinuscopic guide using adenoid curette and microdebrider. All children were examined by echocardiography one day before and one month after adenoidectomy. Velocity time integral of tricuspid valve flow (VTItv) and pulmonary valve flow (VTIpa); E/ A ratio of tricuspid valve flow; RV end-diastolic diameter (RVEDd) and left ventricle fraction shortening (FS) were measured. Heart rate (HR) was also recorded. Results Preoperatively VTItv, VTIpa, E/ A ratio, RVEDd, FS, and HR were 18.6 ± 3.0 cm, 20.8 ± 3.1 cm, 1.21 ± 0.31, 11.5 ± 2.1 mm, 35.1 ± 4.3%, and 112 ± 19, respectively. Postoperatively VTItv, VTIpa, E/ A ratio, RVEDd, FS, and HR were 21.5 ± 2.5 cm, 24.4 ± 4.3 cm, 1.44 ± 0.32, 9.3 ± 2.6 mm, 33.9 ± 3.5%, and 104 ± 28, respectively. There were significant differences between preoperative and postoperative VTItv ( p = 0.03), VTIpa ( p = 0.01), E/ A ratios ( p = 0.04), and RVEDd ( p = 0.01). FS and HR were not significantly different. Conclusions This study illustrated that in children suffering from AH, relieving upper airway obstruction by adenoidectomy may result in improvement of RV filling and RVO, associated with the reduction in PAP.

Outcome of balloon sinuplasty vs adenoidectomy in children

Outcome of balloon sinuplasty vs adenoidectomy in children

The Effects of Dexmedetomidine and Fentanyl on Emergence Characteristics after Adenoidectomy in Children

This randomised controlled study evaluated the effects of fentanyl and dexmedetomidine on emergence characteristics of children having adenoidectomy and anaesthetised with sevoflurane. Ninety children, two to seven years of age and ASA physical status I, were studied. Children were randomly assigned to one of three groups of 30 children, with the study intervention injection given intravenously after intubation. Children in Group F received fentanyl 2.5 microg x kg(-1), children in Group D received dexmedetomidine 0.5 microG x kg(-1) and children in Group C received saline solution. Anaesthesia was induced with 50% N2O and 8% sevoflurane in O2 by mask and atracurium 0.6 mg x kg(-1) was administered for tracheal intubation. All children received paracetamol 40 mg/kg rectally one hour preoperatively and dexamethasone 0.5 mg x kg(-1) intravenously. The time to extubation was shorter in Group D than Group F. The eye-opening time was longer in Group F (16.1 +/- 5.3 minutes) than in Groups C (12.0 +/- 4.2 minutes) and D (12.7 +/- 3.2 minutes). The proportion of pain-free children in early recovery was significantly higher in Groups D (47%) and F (43%) than Group C (13%) (P < 0.05). The proportion of children with agitation scores > 3 was lower in Groups D 17% (5/30) and F 13% (4/30) than in Group C 47% (14/30) (P < 0.05). Fentanyl 2.5 microg x kg(-1) and dexmedetomidine 0.5 microg x kg(-1) had similar haemodynamic effects and emergence characteristics. Fentanyl has been safely used in children for many years. Further studies of dexmedetomidine safety and its interaction with other anaesthetic agents are required before recommending its routine use during general anaesthesia in children.

Tonsillectomy and Adenoidectomy in Children with Sleep-Related Breathing Disorders: Consensus Statement of a UK Multidisciplinary Working Party

During 2008, ENT-UK received a number of professional enquiries from colleagues about the management of children with upper airway obstruction and uncomplicated obstructive sleep apnoea (OSA). These children with sleep-related breathing disorders (SRBDs) are usually referred to paediatricians and ENT surgeons. In some district general hospitals, (DGHs) where paediatric intensive care (PICU) facilities to ventilate children were not available, paediatrician and anaesthetist colleagues were expressing concern about children with a clinical diagnosis of OSA having routine tonsillectomy, with or without adenoidectomy. As BAPO President, I was asked by the ENT-UK President, Professor Richard Ramsden, to investigate the issues and rapidly develop a working consensus statement to support safe but local treatment of these children. The Royal Colleges of Anaesthetists and Paediatrics and Child Health and the Association of Paediatric Anaesthetists nominated expert members from both secondary and tertiary care to contribute and develop a consensus statement based on the limited evidence base available. Our terms of reference were to produce a statement that was brief, with a limited number of references, to inform decision-making at the present time. With patient safety as the first priority, the working party wished to support practice that facilitated referral to a tertiary centre of those children who could be expected, on clinical assessment alone, potentially to require PICU facilities. In contrast, the majority of children who could be safely managed in a secondary care setting should be managed closer to home in a DGH. BAPO, ENT-UK, APA, RCS-CSF and RCoA have endorsed the consensus statement; the RCPCH has no mechanism for endorsing consensus statements, but the RCPCH Clinical Effectiveness Committee reviewed the statement, concluding it was a 'concise, accurate and helpful document'. The consensus statement is an interim working tool, based on level-five evidence. It is intended as the starting point to catalyze further development towards a fully structured, evidence-based guideline; to this end, feedback and comment are welcomed. This and the constructive feedback from APA and RCPCH will be incorporated into a future guideline proposal.

Relationship of Opioid Analgesic Protocols to Assessed Pain and Length of Stay in the Pediatric Postanesthesia Unit Following Tonsillectomy

After tonsillectomy and adenoidectomy in children, postoperative pain management is an essential, yet often challenging, task. In addition to discomfort, lack of pain management can lead to delays in oral intake of patients, resulting in extended stays and increased costs. At one North Texas pediatric facility, postoperative coblation tonsillectomy and adenoidectomy pain management orders include the as-needed use of both intravenous fentanyl and intravenous morphine. Both drugs are effective and both have potential side effects that might prolong the recovery period. Nurses in the postanesthesia care unit retrospectively compared a fentanyl and morphine regimen with a morphine-only regimen to determine whether either protocol made a difference in length-of-stay or pain relief. Analysis of available data revealed no statistically significant differences in length of stay between the groups and trivial differences thought to be clinically irrelevant on other variables.

Tonsillectomy and adenoidectomy in children with sleep related breathing disorders: consensus statement of a UK multidisciplinary working party

During 2008, ENT-UK received a number of professional enquiries from colleagues about the management of children with upper airway obstruction and uncomplicated obstructive sleep apnoea (OSA). These children with sleep-related breathing disorders (SRBDs) are usually referred to paediatricians and ENT surgeons. In some district general hospitals, (DGHs) where paediatric intensive care (PICU) facilities to ventilate children were not avail able, paediatrician and anaesthetist colleagues were expressing concern about children with a clinical diagnosis of OSA having routine tonsillectomy, with or without adenoidectomy. As BAPO President, I was asked by the ENT-UK President, Professor Richard Ramsden, to investigate the issues and rapidly develop a working consensus statement to support safe but local treatment of these children. The Royal Colleges of Anaesthetists and Paediatrics and Child Health and the Association of Paediatric Anaesthetists nominat ed expert members from both secondary and tertiary care to contribute and develop a consensus statement based on the limit ed evidence base available. Our terms of reference were to produce a statement that was brief, with a limited number of references, to inform decisionmaking at the present time. With patient safety as the first priority, the working party wished to support practice that facilitated referral to a tertiary centre of those children who could be expected, on clinical assessment alone, potentially to require PICU facilities. In contrast, the majority of children who could be safely managed in a secondary care setting should be managed closer to home in a DGH. BAPO, ENT-UK, APA, RCS-CSF and RCoA have endorsed the consensus statement; the RCPCH has no mechanism for endors ing consensus statements, but the RCPCH Clinical Effectiveness Committee reviewed the statement, concluding it was a ‘concise, accurate and helpful document’. The consensus statement is an interim working tool, based on level-five evidence. It is intended as the starting point to catalyze further development towards a fully structured, evidence-based guideline; to this end, feedback and comment are welcomed. This and the constructive feedback from APA and RCPCH will be incorporated into a future guideline proposal. This consensus statement is also being published by all the working party host organisations and will appear in the RCoA Bulletin, Clinical Otolaryngology and on the RCPCH website

A Cost-Effectiveness Analysis of Coagulation Testing Prior to Tonsillectomy and Adenoidectomy in Children.

BACKGROUND: Obtaining laboratory studies to screen for a coagulation disorder prior to tonsillectomy and/or adenoidectomy (T&A) is a controversial procedure. The American Society of Pediatric Otolaryngology advises that such studies only be performed when indicated by history or physical exam. Nevertheless, many surgeons in clinical practice proceed with testing on all children scheduled for T&A. Several observational studies of pre-operative testing have been performed over the past four decades with conflicting results. The cost-effectiveness of this screening has not been studied in a rigorous, formal manner. We constructed a decision analysis model to address the costs and health outcome states of coagulation screening strategies for children undergoing T&A.METHODS: A 14-day Markov model was constructed to test three pre-operative screening strategies:test all children for coagulation disorders;test only those children with a pertinent history or physical exam (PE) finding; andperform no pre-operative testing on any child.We performed a literature search to estimate the prevalence of abnormal pre-operative coagulation tests, the prevalence of true coagulation disorders among those patients, the rates of bleeding following T&A, and the mortality following T&A. From published sources, we obtained cost data on laboratory studies, hospital admissions (surgical and observational), hematology consultation, medications for prophylaxis and treatment of a bleeding disorder, and lost parental wages. We estimated quality of life (utility) data from published national sources. Parameters were varied widely in sensitivity analyses based upon the range of reported values. Using a societal perspective and a cycle length of one day, we compared the three strategies based on total costs and quality-adjusted life-years (QALYs).RESULTS: Total costs for the three strategies were $3200 for testing all children, $3083 for testing only children with a history or PE finding, and $3077 for not testing children. Total utilities followed a reversed pattern with 0.02579 QALYs for testing all, 0.02654 QALYs for testing some, and 0.02659 QALYs for not testing. These results indicate that the strategy of not testing children prior to surgery dominates the others; it is both less expensive and has a higher utility. Cost-effectiveness ratios were sensitive to variation in the overall prevalence of post-operative bleeding, the cost of post-operative care, and the cost of diagnostic coagulation testing after a post-operative hemorrhage. However, the strategy of not testing children pre-operatively was dominant throughout all sensitivity analyses.DISCUSSION: Our results demonstrate that universally screening all children for coagulation disorders prior to T&A is not cost-effective. Furthermore, not performing any preoperative testing appears to be the most cost-effective strategy. This study does not prove the superiority of one strategy over another, though it does offer advantages over single institution observational studies. Given the short time duration of the model, absolute cost and utility differences between strategies are small. However, these differences are persistent in sensitivity analyses, indicating that the model is robust. The analysis provides evidence that suggests pre-T&A coagulation testing in children should be used judiciously at most. Detailed conversations between surgeon, patient, and family about the risks, benefits, and costs of such testing should determine its selective use.

Use of the Laryngeal Mask Airway in Preventing Airway Fires during Adenoidectomies in Children: A Study of 25 Patients

We report the results of our study of 25 children who underwent adenoidectomy under general anesthesia with a laryngeal mask airway to determine their risk of fire in the oropharynx. We explain the distinct advantage that such an anesthetic technique has with respect to minimizing the conditions that may contribute to an airway fire. We also discuss additional advantages of using a laryngeal mask airway during adenoidectomies.

Tonsillectomy and Adenoidectomy Are Not Associated With an Altered Risk of Childhood-Onset Type 1 Diabetes

Type 1 diabetes results from the autoimmune destruction of the pancreatic β-cells. As various studies have shown that tonsillectomy and adenoidectomy, particularly in childhood, impact the function of the immune system (1), it is possible that these procedures could increase a child’s risk of type 1 diabetes. Conversely, the hygiene hypothesis (2) suggests that frequent exposure to infections in early life may protect against type 1 diabetes. Therefore, children undergoing tonsillectomy and adenoidectomy may be expected to have a reduced risk of type 1 diabetes because they are likely to have experienced higher rates of respiratory and ear infections in early childhood than other children. Previously, a Finnish case-control study (3) of type 1 diabetes with adenoidectomy reported a modest though not significant increase in the risk of diabetes, while a possible association with tonsillectomy has been investigated only in a small Canadian case-control study (4). The aim of this study was to investigate, for the first time in a cohort setting, the risk of type 1 diabetes after tonsillectomy and/or adenoidectomy in children identified from hospital records. Northern Ireland hospitals routinely record the name, date of birth, and hospital number of each individual undergoing a surgical procedure. The type of procedure is …

Oral naproxen but not oral paracetamol reduces the need for rescue analgesic after adenoidectomy in children

Our aim was to show the efficacy of naproxen and paracetamol with and without pethidine on pain and nausea and vomiting after adenoidectomy. The primary outcome was the requirement of rescue analgesic for post-operative pain and the secondary outcome was post-operative nausea and vomiting (PONV). A randomized, double-blind, placebo-controlled study design was used. Thirty minutes before anaesthesia induction, patients (n= 180) received either a single oral dose analgesic (naproxen 10 mg/kg or paracetamol 20 mg/kg) or a placebo. Half of the children received pethidine 1 mg/kg intravenously (i.v.) at the induction of anaesthesia. Post-operative pain was evaluated using an objective behavioural pain scale (OPS 0-9) and rescue medication, i.v. fentanyl 1 mug/kg, was administered if the child suffered from moderate or severe pain (OPS > or = 4). When pethidine was not used, 83% of the children in the naproxen group vs. 97% in the other two groups required rescue fentanyl (P < 0.05). The use of pethidine reduced the incidence of fentanyl requirement by 30% and the number of fentanyl doses by 50% (P < 0.001). It also equalized the effects of naproxen, paracetamol and the placebo making the pain model invalid for this kind of study. The drawback associated with better analgesia was a doubling of the incidence of PONV (P < 0.001). Oral naproxen (10 mg/kg), but not oral paracetamol (20 mg/kg), reduces the need for rescue analgesic after adenoidectomy in children. The sensitivity of the pain model is crucial for these types of studies.