Secondary Hemorrhage Research Articles

Comparison between Tonsillectomy by Coblation, Bipolar and Surgical Dissection

Abstract Background Tonsillectomy is one of the most common paediatric surgical procedures performed worldwide. Although it is one of the most widely performed procedures in otorhinolaryngology, none of the commonly used techniques for tonsillectomy is considered optimal till now. Objective To compare coblation, bipolar diathermy, and surgical dissection approaches for tonsillectomy in terms of operative time, surgical blood loss, postoperative pain and the incidence of postoperative complications. Methods A systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. Guidelines and an electronic search of information was conducted to identify studies that compare between coblation, cold dissection and bipolar diathermy techniques. Results This study showed that bipolar diathermy tonsillectomy was the lowest risk of primary bleeding followed by coblation then cold dissection tonsillectomy but with insignificant difference. Coblation technique was the highest secondary bleeding risk followed by cold dissection and the lowest risk was figured in bipolar diathermy procedure also the difference did not reach statistical significance. Coblation tonsillectomy was the best technique regarding blood loss and operative time with significant difference in the comparison with cold dissection and insignificant in the comparison with bipolar diathermy. Because of using a different postoperative pain measures in the studies we could not pool its data, but the majority of studies showed that coblation technique was better as regard postoperative pain than cold dissection and bipolar diathermy. While there was no significant difference between cold dissection and bipolar diathermy in the most studies Conclusion Overall, bipolar diathermy procedure for tonsillectomy was considered the best technique regarding primary and secondary bleeding outcomes, but the difference did not reach statistical significance. Coblation procedure for tonsillectomy was considered the best technique regarding intraoperative blood loss with significant difference except in comparison between bipolar diathermy and coblation the difference was not significant. Coblation technique also considered the best one regarding operative time with significant difference in direct comparison between coblation and cold, and insignificant in other comparisons. By systematic review on 21 studies coblation technique shows less postoperative pain than cold dissection and bipolar diathermy in the majority of studies comparing coblation with every technique. And there was no significant difference between studies compared cold dissection with bipolar diathermy regarding postoperative pain.

Comparison of Postoperative Secondary Haemorrhage Rates and Pain Threshold between Conventional Cold Dissection, Bipolar, Monopolar Electrocautery and Laser Tonsillectomy, Meta Analysis Study

Abstract Background Tonsil surgery is one of the most common surgical procedures performed in otorhinolaryngology. The earliest known removal of tonsils was performed by Celsius in the first century A.D. Aim of the Work To compare the postoperative secondary haemorrhage rates and pain threshold between conventional cold dissection, bipolar, monopolar electrocautery and laser tonsillectomy. Patients and Methods This review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. An initial search will be carried out using the PubMed, Cochrane library Ovid, Scopus & Google scholar using the following keywords: Dissection, Diathermy, Laser electrocautery, Tonsillectomy. Results Highly significant decrease in mean 7-day post-operative pain score, in conventional dissection group compared to diathermy group (p < 0.01). Significant decrease in mean 7-day post-operative pain score, in conventional dissection group compared to laser electrocautery group (p = 0.024). Nonsignificant difference in mean 7-day post-operative pain score, in diathermy group compared to laser electrocautery group (p > 0.05). Non-significant difference in revision or re-operation rate, in conventional dissection group compared to diathermy group (p > 0.05). Non-significant difference in secondary haemorrhage rate, in conventional dissection group compared to diathermy group (p > 0.05). Non-significant difference in secondary haemorrhage rate, in conventional dissection group compared to laser electrocautery group (p > 0.05). Conclusion Based on the findings of the present study, all the methods used in the study are safe but there was significant decrease in mean 7-day post-operative pain score using conventional dissection method compared to diathermy and laser electrocautery methods with no difference found in secondary haemorrhage rates between different methods used.

Dynamic hydrogel with environment-adaptive autonomous wound-compressing ability enables rapid hemostasis and inflammation amelioration for hemorrhagic wound healing

Severe trauma wound management remains a crucial challenge in the clinics owing to the uncontrollable bleeding and acute inflammatory responses. To achieve rapid hemostasis and reduce local inflammation of large hemorrhagic wounds, we proposed a composite hydrogel dressing through the free radical polymerization of methacrylate gelatin (GelMA), bisphosphonic acid (BP) and cyclodextrin (CD)-modified hyaluronic acid (HA) and loaded with anti-inflammatory drug resveratrol (RES) through supramolecular inclusion. After implantation into bleeding wounds, the hydrogel could electrostatically enrich blood cells and platelets around the wound area to accelerate thrombosis and also increase its own weight to compress local blood vessels for reducing blood loss. Moreover, the cross-linking degree of the HG-CB-based hydrogels could be enhanced in a self-evolving manner through coordination between BP and blood-derived iron ions, leading to increasing biomechanical performance to avoid hydrogel rupture and secondary bleeding. In addition, the hydrogel continuously released RES to increase secretion of anti-inflammation factors, which may stimulate fibroblast migration and accelerate collagen deposition at the wound site. Overall, the HG-CB-based composite hydrogels exhibited excellent rapid hemostatic properties for treating large bleeding wounds and accelerated wound repair via RES-mediated inflammation amelioration, which may provide an approach for managing severe traumatic wounds in the clinics.

The Two-Tube Method for Treating Thoracogastric Airway Fistula.

Thoracogastric airway fistula (TGAF) is a fatal complication after esophagectomy. Without active treatment, patients may die of intractable pneumonia, sepsis, massive hemoptysis, or respiratory failure. We determined the clinical value of the two-tube method that involves the precise interventional placement of the nasojejunal tube (NJT) and nasogastric tube (NGT) for TGAF. Clinical data of patients with TGAF who had undergone fluoroscopic interventional placement of NJT and NGT were analyzed retrospectively. The paired t-test was used to compare the index values before and after treatment. Statistical significance was set at p < 0.05. In total, 212 patients (177 male and 35 female; mean age, 61.3 ± 7.9 years [47-73]) with TGAF who had undergone the two-tube method were included. Posttreatment chest spiral computed tomography and inflammatory indicators showed significantly improved pulmonary inflammation compared with that before treatment. The patients' general condition remained stable. Of 212 patients, 12 (5.7%) underwent surgical repair, 108 (50.9%) received placement of airway stents, and 92 (43.4%) cases only continued treatment with the two-tube method owing to patients' conditions. In total, 47.8% (44/92) patients died of secondary pulmonary infection, bleeding, and primary tumor progression, whereas 52.2% (48/92) patients survived with both tubes. The two-tube method, which involves the precise interventional placement of the NJT and NGT, is simple, safe, and effective for treating TGAF. This method is a bridge for successive treatments or a treatment itself for patients who are unsuitable for surgical repair or stent placement.

A Novel Technique of Renorrhaphy in Difficult Partial Nephrectomies by Single-Layered Parenchymal Imbrication.

Background In partial nephrectomies, achieving the trifecta outcome of negative tumor margins, no surgical complications, and minimal decline in renal function depends on various factors, with the complexity of the tumor described by the nephrometry score being chief among them. These factors often motivate surgeons towarda minimally invasive route even if the preferred route is an open approach. We describean innovative renorrhaphytechnique that overcomes the commonly encountered difficulty in reconstructing the renal parenchyma after resecting a complex tumor with a single-layered parenchymal imbrication (SLPI) technique. Methodology We conducted a retrospective review of case records of the patients who had undergone partial nephrectomies in our center from March 2017 toMarch 2021. The patients who underwent the SLPI technique were chosen, and data were extracted. Data collected included patients' preoperative imaging findings; intraoperative parameters such as ischemia time, blood loss, and number of renal arteries; and postoperative factors such as margin positivity rate, urine leak, secondary bleeding, follow-up imaging, and recurrence rates. Results A total of 28 patients were included in our study. The estimated blood loss was 234 mL (standard deviation [SD] = 55 mL), warm ischemia time was 31 minutes (SD 4 minutes), a hospital stay of 3 days (SD 2 days), two minor complications, two intraoperative complications, and one margin positivity. There were no major complications or recurrences. Conclusions The novel technique of SLPI renorrhaphy can help deal with complex renal masses and is an easily reproducible technique both in open and minimally invasive approaches.

Adenoid hypertrophy-​diagnosis and treatment: the new S2k guideline.

Hyperplasia of the pharyngeal tonsils is to be considered pathologic when nasopharyngeal symptoms of mechanical obstruction and/or chronic inflammation occur. Chronic Eustachian tube dysfunction can result in various middle ear diseases such as conductive hearing loss, cholesteatoma, and recurrent acute otitis media. During examination, attention should be paid to the presence of adenoid facies (long face syndrome), with apermanently open mouth and visible tip of the tongue. In the case of severe symptoms and/or failure of conservative treatment, adenoidectomy is usually performed on an outpatient basis. Conventional curettage remains the established standard treatment in Germany. Histologic evaluation is indicated for clinical evidence of mucopolysaccharidoses. Due to the risk of hemorrhage, the preoperative bleeding questionnaire, which is obligatory before every pediatric surgery, is referred to. Recurrence of adenoids is possible despite correct adenoidectomy. Before discharge home, otorhinolaryngologic inspection of the nasopharynx for secondary bleeding should be performed and anesthesiologic clearance obtained.

Comparative study between tonsillectomy with thermal welding and conventional cold steel techniques

Various tonsillectomy techniques had been adopted for many years; however, the ambition is the access to an entirely safe and efficient modality. This study aims to compare efficacy of thermal welding and cold steel dissection tonsillectomy techniques. A prospective study, in Al-Yarmouk teaching hospital, Baghdad, Iraq, from 2017 to 2018, were done, in whom 100 eligible patients for tonsillectomy, were evenly and randomly divided into group "A" whom underwent thermal welding tonsillectomy, and group "B" whom underwent cold steel dissection tonsillectomy. The outcomes of both groups were assessed for operative time, intraoperative blood loss, postoperative hemorrhages, postoperative pain, speed of tonsillar fossae healing process, and time return to normal diet. Results shown operative time was 11.0±1.4 min in group "A", and 29.6±12.4 min in group "B", P=0.001, mean amount of intraoperative blood loss was 17.4±1.3 ml in group "A", and 53.2±18.8 ml in group "B", P=0.001, primary and secondary postoperative hemorrhages statically significant lower in group “A”, P=0.025. Mean postoperative pain score in the group "A" was 1.6± 0.5, and in group "B" 2.725±0.7, P=0.001, as well as, mean time to return to normal diet was 5.4± 0.8 days in group "A", and 8.2±0.4 days in group "B", P=0.012, also tonsillar fossae healing process was clinically faster in group "A". So it concluded, thermal welding tonsillectomy showed better outcomes regarding reduction in both intraoperative blood loss, postoperative hemorrhages, postoperative pain, also shortening in operative time and quicker return to normal diet, as well as, clinically faster tonsillar fossae healing process.

P-781 Assisted reproductive technology-associated risk factors for retained placenta

Abstract Study question What are the assisted reproductive technology-associated risk factors for retained products of conception (RPOC) following delivery? Summary answer Frozen embryo transfer (FET) with hormone replacement cycles (HRC) constitutes the largest risk factor for RPOC. What is known already RPOC is a key cause of secondary postpartum hemorrhage. Previous studies have shown that the use of ART increases the risk of RPOC and subsequent transfusion following delivery. However, the relationships between specific ART-treatment factors and the risk of RPOC have not been elucidated. Study design, size, duration We performed a registry-based retrospective cohort study using the Japanese national ART registry, in which all the ART cycles performed in Japan are recorded including the perinatal outcomes. Participants/materials, setting, methods Singleton live births between 2007 and 2017 were studied (n = 306,411). Odds ratios (ORs) and 95% confidence intervals (CIs) for the potential risk factors for RPOC associated with fresh and frozen cycles were obtained from multiple logistic regression analysis, incorporating adjustment for maternal age, infertility, and calendar year. Because information regarding assisted hatching (AH) and HRC for endometrial preparation only became available in 2012, these factors were analysed using the data collected between 2012 and 2017. Main results and the role of chance RPOC was diagnosed for 132 deliveries (0.04%), of which 122 (92.4%) followed FET cycles and only 10 (0.01%) followed fresh embryo transfer (ET). No significant risk factors for RPOC were identified using the fresh ET data. For FET cycles, the use of HRC as an endometrial preparation method represented the largest risk factor (adjusted OR, 4.9; 95% CI, 2.0 to 12.3), with RPOC occurring in 0.05% of deliveries following HRC (51/97, 958 deliveries) but in only 0.01% following natural cycles (5/47, 79 deliveries). AH was also associated with a significantly higher risk of RPOC (adjusted OR, 1.9; 95% CI, 1.2 to 3.1), although the risk was lower than that associated with HRC). Subgroup analysis showed that these significant associations of HRC and AH with RPOC were present for transvaginal deliveries, but not deliveries by caesarean section. Limitations, reasons for caution The registry lacks important information regarding risk factors for RPOC, such as parity, body mass index, and history of previous uterine surgery. Furthermore, the lower prevalence of RPOC in the present study (0.04%) than in other studies (approximately 1%) suggests the possibility of non-differential misclassification for the outcomes of RPOC. Wider implications of the findings Although the possibility of residual confounding factors remains, the present findings suggest that additional care should be taken in the management of patients undergoing vaginal deliveries following FET who have HRC or AH. Trial registration number Not applicable

Prevalence of Subarachnoid Hemorrhage in Traumatic Brain Injury Patients: A Cross-Sectional Study

Background: One of the clinical manifestations and complications of traumatic brain injury patients is traumatic intracranial hemorrhages, divided into primary and secondary hemorrhages. Objectives: The present study was conducted to determine the prevalence of subarachnoid hemorrhage (SAH) in traumatic brain injury (TBI) patients. Methods: The present cross-sectional study was conducted on all TBI patients with SAH for one year. Data collection tools include a demographic profile form and a researcher-made checklist. The severity of TBI is divided according to the Glasgow Coma Scale (GCS) score. The patient’s history and clinical examinations were considered when admitting to the hospital. The consciousness level was measured at 6-to-24-hour intervals, a computed tomography (CT) scan was performed, and any abnormal SAH-related clinical findings and symptoms were recorded. If the patient had other hemorrhages besides SAH, the hematoma volume was recorded. The collected data were entered into and analyzed by SPSS version 16 software. Results: A total of 534 patients were investigated, of whom 84 (15.3%) had intracranial hemorrhage. Out of 84 patients with intracranial hemorrhage, 12 (2.2%) had SAH, of whom ten were male and 2 were female. Also, SAH occurred to traffic accidents, falls, and other related reasons in 7 (58.3%), 4 (33.3%), and 1 (8.3%) patients, respectively. It was also shown that 1 (8.3%), 2 (16.6%), and 9 (75%) patients with SAH had mild, moderate, and severe consciousness, respectively. Regarding the frequency of SAH-related diseases, it was shown that 2 (16.6%) and 10 (82.3%) patients were diabetic and non-diabetic, 4 (33.3%) and 8(66.6%) patients were hypertensive and non-hypertensive, and 7 (58.3%) and 5 (41.6%) patients were with and without a history of skull fractures, respectively, 12 (100%) of them had a history of coagulation disorders. Conclusions: The prevalence of intracranial hemorrhage and SAH in TBI patients is significantly high, which should be taken into consideration when performing diagnostic and therapeutic procedures for these patients.

Analysis of the risk factors for secondary hemorrhage after abdominal surgery.

This study aimed to conduct a clinical review and analysis to recommend options for the prevention and treatment of postoperative hemorrhage. A total of 138 patients who experienced postoperative hemorrhage after abdominal surgery in the period between January 2015 and December 2020 at the Sir Run Run Shaw Hospital, affiliated to Zhejiang University School of Medicine, participated in this study. They were divided into a group with primary bleeding only and a secondary bleeding group. Univariate and multivariate statistical analyses were performed, followed by plotting of cumulative hazard and survival curves for the two groups. The main factors of interest found to be associated with secondary hemorrhage were duration of the operation, the time of the first bleeding incident, intervention time, performance of combined organ resection, use of surgical intervention, occurrence of abdominal infection, admission to the intensive care unit (ICU), postoperative length of stay, and total hospitalization expenses. Among these, a long operative duration (>5 h) and an extended intervention time (>5 h) were identified as independent predictors of risk of secondary hemorrhage. Secondary hemorrhage after abdominal surgery is mainly associated with subjective human factors, and it is an important cause of poor prognosis and even death. Proper reductions in operation time and implementation of a quick response to bleeding are the key factors in tackling bleeding. Further reduction in the rates of postoperative hemorrhage and mortality will require a concerted effort by surgeons in terms of both intraoperative surgical techniques and postoperative management.

Iatrogenic uterine vascular lesion: A rare cause of secondary postpartum hemorrhage– case report

Iatrogenic uterine vascular lesion: A rare cause of secondary postpartum hemorrhage– case report

Usefulness of transcatheter arterial embolization for eighty-three patients with secondary postpartum hemorrhage: Focusing on difference in angiographic findings.

Transcatheter arterial embolization (TAE) has been widely used as an effective and a safe treatment method and was often used as an alternative to the surgical management, but there are limited studies on the efficacy and the safety for patients undergoing their secondary postpartum hemorrhage (PPH). To evaluate the usefulness of TAE for secondary PPH focusing on the angiographic findings. We conducted a research from January 2008 to July 2022 on all 83 patients (mean: 32 years, range: 24-43 years) presented with secondary PPH and they were treated with TAE in two university hospitals. The medical records and angiography were retrospective reviewed in order to evaluate the patients' characteristics, delivery details, clinical status and peri-embolization management, angiography and embolization details, technical/clinical success and complications. The group with active bleeding sign and the group without it were also compared and analyzed. On angiography, 46 (55.4%) patients showed active bleeding signs such as contrast extravasation (n = 37) or pseudoaneurysm (n = 8) or both (n = 1), and 37 (44.6%) patients showed non-active bleeding signs such as only spastic uterine artery (n = 2) or hyperemia (n = 35). In the active bleeding sign group there were more multiparous patients, low platelet count, prothrombin time prolongation, and high transfusion requirements. The technical success rates were 97.8% (45/46) in active bleeding sign group and 91.9% (34/37) in non-active bleeding sign group, and the overall clinical success rates were 95.7% (44/46) and 97.3% (36/37). An uterine rupture with peritonitis and abscess formation occurred to one patient after the embolization, therefore hysterostomy and retained placenta removal were performed which was a major complication. TAE is an effective and a safe treatment method for controlling secondary PPH regardless of angiographic findings.

An aminocaproic acid-grafted chitosan derivative with superior antibacterial and hemostatic properties for the prevention of secondary bleeding

Uncontrolled bleeding is one of the leading causes of human mortality. Existing hemostatic materials or techniques cannot meet the clinical requirements for safe and effective hemostasis. The development of novel hemostatic materials has always been of great interest. Chitosan hydrochloride (CSH), a derivative of chitin, is extensively used on wounds as an antibacterial and hemostatic agent. However, the formation of intra- or intermolecular hydrogen bonds between hydroxyl and amino groups limits its water solubility and dissolution rate and affects its effectiveness in promoting coagulation. Herein, we covalently grafted aminocaproic acid (AA) to the hydroxyl and amino groups of CSH via ester and amide bonds, respectively. The solubility of CSH in water (25 °C) was 11.39 ± 0.98 % (w/v), whereas the AA-grafted CSH (CSH-AA) reached 32.34 ± 1.23 % (w/v). Moreover, the dissolution rate of CSH-AA in water was 6.46 times higher than that of CSH. Subsequent studies proved that CSH-AA is non-toxic, biodegradable, and has superior antibacterial and hemostatic properties to CSH. Additionally, anti-plasmin activity can be exerted by the dissociated AA from the CSH-AA backbone, which can help to lessen secondary bleeding.

Embolization of midbrain arteriovenous malformation fed by the artery of Percheron in a child, the first case report and literature review.

Artery of Percheron (AOP) as main feeder artery of arteriovenous malformation (AVM) is extremely rare. Two cases of thalamic AVM fed by AOP have been reported to date and only one AVM been removed by microsurgery when attempt of intervention embolization failed. Midbrain AVM fed by AOP has not been reported yet. Here, we presented the first successful embolized case of midbrain AVM supplied by the AOP in a 10-year-old boy, who suffered dual oculomotor nerve palsy and secondary hemorrhage before embolization. During endovascular embolization, selective angiography by 1.2 Fr. Magic microcatheter showed an intranidal aneurysm located on the distal AOP. Two injections of a 1:4 ratio mixture of NBCA-MS completely occlude the nidus and intranidal aneurysm with no complications occurred. The child recovered well and the oculomotor deficits improved. This case highlighted that AOP is a clinically significant branch associated with AVM in midbrain and thalamus. Moreover, intervention embolization of midbrain AVM fed by AOP is a considerable therapeutic strategy.

Cone cavernoma with a twice secondary intramedullary hemorrhage

Possible complications that may occur and how to solve them before surgery are essential. This case is of special interest for being a low-incidence pathology in a rare location. The case is of high interest because of the importance of evacuating the hemorrhage to prevent sequels and the complexity of its management and highlights the importance of considering the diagnosis of this event.

Long-term safety and effectiveness of vonoprazan for prevention of gastric and duodenal ulcer recurrence in patients on nonsteroidal anti-inflammatory drugs in Japan: a 12-month post-marketing surveillance study

ABSTRACT Background This study assessed the safety and effectiveness of vonoprazan for prevention of duodenal and gastric ulcer recurrence in patients on long-term nonsteroidal anti-inflammatory drugs (NSAIDs) in routine clinical practice. Research design and methods This 12-month, prospective, observational study (145 sites, Japan, September 2016–April 2020) analyzed patients with a history of gastric or duodenal ulcer who started once-daily vonoprazan and were receiving NSAIDs for pain. The primary outcome was the incidence of adverse drug reactions (ADRs). Results Most patients (86.7% [1099/1268]) received vonoprazan for at least 6 months. Most patients (98.6% [1250/1268]) received the 10-mg dose of vonoprazan, 38.3% (486/1268) received cyclooxygenase-2 inhibitors, and 61.7% (782/1268) received other NSAIDs. The overall incidence of ADRs was 0.71% (9/1268). Most commonly reported ADRs were gastrointestinal (0.32%), nervous system (0.16%), and hepatobiliary system (0.16%) disorders. The overall incidence of gastric or duodenal ulcer recurrence was 1.04% (95% CI 0.56–1.78). Conclusions No new safety concerns were reported for vonoprazan for prevention of secondary ulcer or bleeding in patients receiving long-term NSAIDs. Vonoprazan was effective for preventing NSAID-related peptic ulcer recurrence in this real-world study. Trial registration ClinicalTrials.gov: NCT03214198; Japan Pharmaceutical Information Center Clinical Trials Information: JapicCTI-163436.

BiZact™ tonsillectomy: Predictive factors for post-tonsillectomy haemorrhage from a 1717 case series.

To determine primary and secondary post-tonsillectomy haemorrhage (PTH) rates and identify predictive factors in a cohort of consecutive adult and paediatric BiZact™ tonsillectomy cases. Retrospective cohort study. Patients from Flinders Medical Centre, Noarlunga Hospital and private otolaryngology practices who underwent BiZact™ tonsillectomy from 2017 to 2020. patient age, indication for tonsillectomy, surgeon experience, time and severity of PTH, including return to theatre. Each secondary PTH was graded using the Stammberger classification. Logistic regression was utilised to identify predictors of secondary PTH. One thousand seven hundred and seventeen patient medical records were assessed (658 adults and 1059 children). The primary PTH rate was 0.1%, and secondary PTH rate was 5.9%. The majority of secondary PTH cases were Stammberger grade A (80/102, 78.4%) requiring observation only. Few secondary PTH required medical intervention (grade B; 9/102, 8.8%), return to theatre (grade C; 12/102, 11.8%), or blood transfusion (grade D; 1/102, 1.0%), with no death reported (grade E; 0/102, 0.0%). Recurrent secondary PTH occurred in 8 patients (0.5%). Predictive factors of secondary PTH in children were surgeon experience with trainees having greater chance of PTH (OR 2.502, 95% CI 1.345-4.654; p = .004) and age of child (OR 1.095, 95% CI 1.025-1.170; p = .007). Surgeon experience was a predictive factor for adults (OR 3.804, 95% CI 2.139-6.674; p < .001). BiZact™ tonsillectomy has a low primary PTH rate, with a secondary PTH rate comparable to other 'hot tonsillectomy' techniques. The majority of PTH events were minor and self-reported. There appears to be a learning curve for trainee surgeons.

A Technical Approach to Anesthesia in the Case of Tonsillectomy

&lt;div class="WordSection1"&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tonsillectomy is the most common surgical procedure performed by an ENT doctor (Throat Nose Ear) in children. This surgery can cause pain, bleeding and swelling in the injured throat. Patient may complain of pain, difficulty swallowing, eating, drinking disorders, nausea and vomiting and fall into a dehydrated state. This can reduce patient satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion:&lt;/strong&gt; Postoperative pain management of tonsillectomy is a concern both by the ENT doctor and by the anesthesiologist. The high incidence of post-tonsillectomy pain or anxiety increases the risk of secondary post-tonsillectomy bleeding. It is necessary to know the mechanism of post operative pain and the negative impact of pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Doctors should give attention to reduce postoperative pain and choose a rational analgesic to overcome post operative tonsillectomy pain.&lt;/p&gt;&lt;/div&gt;

The impact of different types of anaesthesia on the course of tonsillectomy surgery

Recurrent tonsillitis is considered to be one of the most common ENT diseases. Tonsillectomy as a method of recurrent tonsillitis' treatment is being performed as usual as 20% of all surgeries in ENT departments. The critical criteria for the success of tonsillectomy for the surgeon are the frequency of perioperative complications, long-term results of treatment, and the patient's recovery time. For the patient, those criteria are the severity of pain, psychoemotional stress, the time spent in the hospital, and how quickly he can return to his daily life routine. The factors that significantly affect the outcome of tonsillectomy are the choice of anaesthetic management.&#x0D; Our study aimed to optimise the approach to choosing between endotracheal anaesthesia and local anaesthesia. Clinical studies were made among 158 patients with recurrent tonsillitis who underwent a bilateral tonsillectomy. The patients were divided into two groups.&#x0D; The first group consisted of 97 patients undergoing tonsillectomy using local anaesthesia. The control group included 61 patients undergoing tonsillectomy using endotracheal anaesthesia. We considered the factors such as duration of surgery, the amount of blood loss, intraoperative events, number of incidents of primary and secondary bleeding, assessment of pain syndrome, necessity of analgesics administration, length of hospital stay, and recovery period.&#x0D; Conclusions: tonsillectomy surgery using local anaesthesia requires less time to perform, has less blood loss, fewer intraoperative events, and fewer incidents of primary and secondary bleeding. The average level of pain is higher in patients using endotracheal anaesthesia.

Post Tonsillectomy Pain Relief: Comparative Study between Peritonsillar Infiltration of Bupivicain and Intramuscular Diclofenac

Hospital based study carried out on (40) patients from both sexes, aged (4-26) years,underwent Tonsillectomy by dissection method during the period extend from (June2012 to September 2012). The Patients were divided into two groups- Group A (18)patients: include those with pre-incisional – infiltration of bupivicain with subsequent(spray) post operatively on Tonsils bed at evening and next morning. Group B (22)patients: include those patients with diclofenac intramuscular injection, half hourbefore operation with subsequent doses at evening and next morning. (Result): nodifference in history of post- operative nausea and vomiting regarding the two groups.The mean operative time for group (A) was (28.9) minutes, while the mean operativetime for group (B) was (29.5) minutes. Both groups showed no difference regardingreactionary bleeding (bleeding occurs within 24 hours) or secondary bleeding(Bleeding occurs after 6-8 days due to infection). Group (A) showed low score of painin immediate post-operative time but it was not significant, while group (B) showedlow score of pain in most of the cases at evening, it was significant. No difference inboth groups in the next morning both showed low score of pain. Conclusion:intramuscular diclofenac is more potent as pain relief if compare with Bupivicaininfiltration. Aim of study: To identify the effect of infiltration of bupivicain for posttonsillectomy pain-relief and in compare to intramuscular injection of diclofenac.