Pediatric Tonsillectomy Patients Research Articles

Early Adverse Respiratory Outcomes in Obese Pediatric Tonsillectomy Patients.

To determine if body mass index (BMI) is predictive of adverse respiratory events (ARE) in the obese pediatric population undergoing tonsillectomy. Case series with chart review. Single institution academic otolaryngology practice. All patients 3 to 12 years old with BMI ≥95th percentile that underwent tonsillectomy March 1, 2011 to July 15, 2020 were included. The study excluded patients with comorbidities that warranted admission independent of BMI, including Trisomy 21, gross developmental delay, neuromuscular disorders, and congenital heart disease. Perioperative AREs following tonsillectomy were recorded. AREs were defined as postoperative desaturation (SpO2 < 90%), intubation, continuous positive airway pressure (CPAP), or new O2 requirement for >2 hours. Eighteen patients (8%) had at least 1 ARE. There were no children age 5 and older with a BMI 95th percentile to 98.9th percentile who had an early adverse respiratory outcome. Preoperative polysomnogram (PSG) metrics, obstructive apnea-hypopnea index (oAHI), and oxygen saturations (SpO2) nadir was significantly different between patients with and without AREs (mean oAHI 54.3 vs 17.4, P = .02; mean SpO2 nadir 73.1% vs 84.5%, P = .05). There was no significant difference in the BMI z score (2.88 vs 2.45, P = .09) between groups. AREs requiring inpatient management are uncommon in obese children after tonsillectomy. BMI is a poor independent indication for admission except at BMI extremes. We found significantly higher oAHI and lower SpO2 nadir on PSG indicate a higher risk for AREs and can guide admission postoperatively. There may be a subset of obese tonsillectomy patients who can be safely discharged home on the day of surgery.

Effectiveness of implementing a standardized perioperative pain management protocol in children undergoing tonsillectomy: A quality improvement project.

Tonsillectomy procedures are commonly performed worldwide. At our academic tertiary care facility, we perform approximately 1000 tonsillectomy procedures annually. We have found inconsistent pain management strategies in pediatric tonsillectomy patients have contributed to variability in postoperative complications and the number and types of postoperative pain medications required in the Post Anesthesia Care Unit (PACU). This project aimed to assess the impact of implementing a standardized perioperative pain management protocol on reducing postoperative complications in pediatric patients who underwent a tonsillectomy procedure. A pre-post-intervention design was utilized, comparing characteristics and outcomes of pediatric patients for whom a standardized perioperative pain management protocol was implemented over a 12-week period compared to those who did not. The standardized perioperative pain management protocol was utilized intraoperatively by the anesthesiologists, nurse anesthetists, and residents. A Qualtrics survey was used by the Post Anesthesia Care Unit (PACU) nurses to gather data as they cared for patients who underwent tonsillectomy. Four outcomes were measured: (1) postoperative pain medication administration, (2) rate of postoperative respiratory complications, (3) rate of adherence, and (4) usability of a standardized pain management protocol. Data were compared between pre and post-implementation groups. During the quality improvement project, 180 children underwent tonsillectomy, with 81 in the control group and 99 in the intervention group. The median age did not differ between groups. The control group had higher postoperative opioid medication usage (93.8% vs. 54.5%) and a higher number of opioids administered in the recovery room. Postoperative IV fentanyl was reduced in the intervention group (49.4% vs. 28.3% in the intervention, p = .004). Respiratory interventions were more frequent in the control group (24.7% vs. 7.1%), with increased respiratory team activation. Respiratory team activation in the Post Anesthesia Care Unit (PACU) includes a 511 page for anesthesia provider assistance. Respiratory interventions included bag-mask ventilation, lidocaine, propofol or succinylcholine administration, and reintubation. The intervention group had 100% adherence to the pain management protocol, and providers found it easy to use. The quality improvement project highlighted notable improvements in the intervention group for whom a standardized perioperative pain management protocol was used, including reduced opioid medication administration, lower incidence of respiratory interventions, and high adherence to the pain management protocol. These findings underscore the effectiveness and feasibility of standardized protocols in enhancing patient outcomes.

When Should We Recommend Intracapsular Tonsillectomy in Pediatric Patients?

When Should We Recommend Intracapsular Tonsillectomy in Pediatric Patients?

Efficacy of peritonsillar infiltration with dexmedetomidine versus tramadol in comparison to placebo for pain control and sedation after tonsillectomy in pediatric patients: A randomized clinical trial.

This article aimed to assess the efficacy of peritonsillar infiltration with dexmedetomidine-ropivacaine versus tramadol-ropivacaine for pain control and sedation after tonsillectomy in pediatric patients. This double-blind clinical trial recruited 99 eligible children (4-8 years old) undergoing tonsillectomy and assigned to three block-randomized groups, receiving dexmedetomidine-ropivacaine (group A), tramadol-ropivacaine (group B), or placebo-ropivacaine (group C). The vital signs included blood pressure, heart rate, and SaO2 before anesthesia induction, during surgery at regular intervals until 24 h after surgery. The duration of surgery and recovery, complications, and analgesic consumption were recorded and pain scores were measured by Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Oucher scales as well as sedation scores by the Wilson sedation scale. Data were analyzed within SPSS 20 at a significance level of 0.05. The lowest pain scores were measured by the CHEOPS scale in the dexmedetomidine-ropivacaine group (P < 0.05). Statistically significant difference was observed in the CHEOPS pain score between the first two groups at 30 min, 1 h, 2 h, and 4 h after surgery (P < 0.01). The differences were revealed in the Oucher pain assessments among all groups from the time of recovery to four postoperative hours (P < 0.05), with the lowest in the dexmedetomidine-ropivacaine group whose sedation score was greater during recovery and 5 min after surgery (P < 0.05). Subjects in tramadol group had six cases of dizziness and nausea, while no side effects were observed in two other groups (P < 0.05). Only seven participants receiving dexmedetomidine required acetaminophen, but 29 in the tramadol group and all in the placebo group demanded to receive acetaminophen (P = 0.001). The authors concluded that dexmedetomidine as an adjuvant to ropivacaine has better performance in local infiltration for intra- and post-tonsillectomy analgesia and postoperative sedation, without any special side effects (like the placebo group), and that it hence is recommended to be used for local infiltration during tonsillectomy.

Comparison of Bizact™ and Bipolar Tonsillectomy in Pediatric Patients

Background: The aim of this study is to compare the effects of Bizact™ and bipolar electrocautery on peroperative and postoperative bleeding, pain, operation time in pediatric patients. Methods: One Hundred and twenty eight (128) pediatric patients who underwent tonsillectomy were included in this prospective study. The patients were operated with indications of recurrent tonsillitis, chronic tonsillitis and obstructive sleep apnea syndrome (OSAS). Patients with a history of bleeding diathesis and peritonsillar abscess were excluded from the study. Results: While the mean peroperative bleeding amount measured in the Bizact™ tonsillectomy group was 16 ml, the mean amount of bleeding in the bipolar cautery group was 65 ml. When the mean operation times were compared, the mean operation time in the Bizact™ group was 15 minutes, and it was significantly lower than in the bipolar cautery group, which was 22 minutes. Patients' postoperative pain scores and return to normal diet were also significantly lower in the Bizact™ group than in the bipolar cautery group. Pain scores of the patients on postoperative 1st, 3rd and 5th days were significantly lower in the Bizact™ tonsillectomy group than in the bipolar cautery group. While bleeding occurred on the 4th day in 1 patient in the bipolar cautery group, no postoperative bleeding was observed in the Bizact™ group. Conclusion: Bizact™ tonsillectomy provides safe peroperative and postoperative bleeding control, less pain, and an earlier return to normal diet and social life.

Estimations of Inpatient and Ambulatory Pediatric Tonsillectomy in the United States: A Cross-sectional Analysis.

To estimate the incidence of inpatient and ambulatory pediatric tonsillectomies in the United States in 2019. Cross-sectional analysis. Healthcare Cost and Utilization Project databases. We determined national incidences of hospital-based ambulatory procedures, inpatient admissions, and readmissions among pediatric tonsillectomy patients, ages 0 to 20 years, using the Kids Inpatient Database, Nationwide Ambulatory Surgery Sample, and Nationwide Readmission Database. We described the demographics, commonly associated conditions, complications, and predictors of readmission. An estimated 559,900 ambulatory and 7100 inpatient tonsillectomies were performed in 2019. Among inpatients, the majority were male (59%) and the largest ethnic group was white (37%). Adenotonsillar hypertrophy (ATH), 79%, and obstructive sleep apnea (OSA), 74%, were the most frequent diagnosis and Medicaid (61%) was the most frequent primary payer. The majority of ambulatory tonsillectomy patients were female (52%) and white (65%); ATH, OSA, and Medicaid accounted for 62%, 29%, and 45% of cases, respectively, (all p < .001 when compared to inpatient cases). Common inpatient complications were bleeding (2%), pain/nausea/vomiting (5.6%), and postprocedural respiratory failure (1.7%). On the other hand, ambulatory complications occurred in less than 1% of patients. The readmission rate was 5.2%, with pain/nausea/vomiting and bleeding accounting for 35% and 23% of overall readmissions. All Patient Refined Diagnosis Related Groups severity of illness subclass predicted readmission (odds ratio = 2.18, 95% confidence interval = 1.73-2.73, p < .001). A total of 567,000 pediatric ambulatory and inpatient tonsillectomies were performed in 2019; the majority were performed in ambulatory settings. The index admission severity of illness was associated with readmission risk.

Gabapentin Premedication to Reduce Postoperative Pain for Pediatric Tonsillectomy/Adenoidectomy: A Pilot Study

PurposeTo examine the effects of preoperative gabapentin administration on postoperative pain in pediatric patients undergoing tonsillectomy/adenoidectomy (T/A) in a single ambulatory surgery location within a pediatric healthcare organization. DesignThis randomized, controlled pilot study enrolled patients age 3–18 years with American Society of Anesthesiologists (ASA) scores of I-II undergoing T/A. MethodsBoth gabapentin and placebo groups were given study medication preoperatively and received standard opiate regimens intraoperatively and postoperative pain instructions. Outcome measurements included: time to first analgesic medication in the postanesthesia care unit (PACU), mean acetaminophen, ibuprofen, and opiate doses in mg/kg. Additionally, we examined pain scores, medication use, and side effects reported by daily pain diaries completed by patients/families for 3 days postoperatively. FindingsForty-nine patients were included in final analysis (gabapentin n = 26, placebo n = 23). Demographic and clinical characteristics of both groups were similar; the majority (46 of 49) were under the age of 13.Both groups received opiates in PACU. Some patients in both groups received hydrocodone/acetaminophen postoperatively. There were no reported differences in side effects between groups. Gabapentin group reported less use of opiates, acetaminophen, and ibuprofen post-discharge. We identified small effect sizes for opiates and acetaminophen, and medium effect size for ibuprofen (80.1% gabapentin versus 100% placebo, RR 0.81 [95% CI 0.67–0.97]).Median pain scores were 4 on a scale of 10 for both groups for all 3 days of follow-up. Overall median satisfaction score was 9, with a mean difference of 0.35 (95% CI -0.78 – 1.37). Analysis of variance revealed no difference in pain scores or satisfaction per pain diaries between the groups in general and no difference in score trajectory. ConclusionsWe were able to establish a rigorous process and feasibility to launch a larger, multi-center trial to examine this important issue. There remain few evidence-based options for acute pain relief in pediatric surgical populations besides opiates. Identifying opiate alternatives that are effective, cost efficient and safe are needed for pediatric tonsillectomy patients.

Efficacy of topical 0.5% bupivacaine in pain reduction in pediatric tonsillectomy patients

BACKGROUND &amp; OBJECTIVE: Palatine tonsils are lymphoid organs in the oropharynx part of the waldeyer's ring and serve as host defence organs with maximum immunological activity from 3-10 years. Tonsillectomy is associated with considerable postoperative pain and requires significant consumption of analgesia. This study aimed to determine effect of topically suffused 0.5% bupivacaine on postoperative tonsillectomy pain.&#x0D; RESULTS One hundred &amp; twenty (120) patients with 61 males and 60-patients in each group with age range of 5-15 years (Group-A=8.63±2.63 and Group-B=8.32±6.60 in). Mean BMI of Group-A and group-B was 15.18±1.60 and 14.96±1.34 respectively (p=0.417). Mean pain score in group-A and group-B was 2.63±0.938 and 6.07±0.800 respectively (p&lt;0.001).&#x0D; CONCLUSION: nsillectomies performed using bupivacaine-soaked packs postoperatively are associated with lower postoperative pain compared with those packed with normal saline.

Development of Eczema Following Tonsillectomy in Pediatric Patients with Upper Respiratory Infections

Development of Eczema Following Tonsillectomy in Pediatric Patients with Upper Respiratory Infections

Predictive Pediatric Characteristics for Revision Tonsillectomy After Intracapsular Tonsillectomy.

There is little research on the rate and risk factors for revision tonsillectomy after primary intracapsular tonsillectomy. Our study aimed to determine the revision rate following intracapsular tonsillectomy, identify patient characteristics that may increase the probability of revision surgery, and report the tonsillar hemorrhage rate after revision. Level III, retrospective case-control study. A tertiary care pediatric center (Alfred I. duPont Hospital for Children, Wilmington, Delaware). A case-control study of pediatric patients who underwent intracapsular tonsillectomy between January 1, 2004, and December 31, 2018, was performed. Patients aged 2 to 20 years were analyzed and compared with matched controls who underwent intracapsular tonsillectomy within 7 days of the same surgeon's case. In total, 169 revision procedures were included with 169 matched controls. A 1.39% revision rate was observed among a total of 12,145 intracapsular tonsillectomies. Among the 169 patients who underwent a revision procedure, the mean time between cases was 3.5 years. Tonsillitis was the most common diagnosis prompting revision tonsillectomy. Four (2.4%) patients underwent operative control of a postoperative tonsillar hemorrhage after revision surgery. Younger patients (P < .001) and patients with a history of gastroesophageal reflux disease (P = .006) were more likely to undergo revision tonsillectomy. Patients below age 4 years and patients with gastroesophageal reflux disease may be at increased risk of undergoing revision tonsillectomy after primary intracapsular tonsillectomy. These factors should be considered when selecting an intracapsular technique for primary tonsillectomy in pediatric patients.

Feasibility of Powered Intracapsular Tonsillectomy in Pediatric Patients with Tonsil Problem, Including Recurrent Tonsillitis: A Single Surgeon’s Experience

Introduction: Powered intracapsular tonsillectomy (PIT) is a technique that protects the tonsillar capsule by using a microdebrider, resulting in faster wound-healing and reduced suffering. Many studies have found PIT to be effective, particularly in pediatric patients with obstructive sleep apnea (OSA). However, previous studies have not included patients with a history of recurrent tonsillitis. Objective: The aim of this study was to determine the efficacy of PIT in pediatric patients even with a history of recurrent tonsillitis, and therefore, we want to expand the indication for PIT and reveal its safety. Methods: A total of 886 pediatric patients underwent PIT between February 2013 and March 2016. All patients rated their postoperative pain using a visual analog scale (VAS) and completed the Korean obstructive sleep apnea (KOSA)-18 questionnaire for assessment of their quality of life (QOL). There were 539 males and 347 females. Their mean age was 6.2 years (range 2–14 years). The majority (77.7%) underwent the operation for OSA, and the rest (22.3%) had a history of recurrent tonsillitis. To compare the efficacy of PIT with traditional tonsillectomy, we selected 191 patients who underwent extracapsular tonsillectomy (ECT), a conventional technique, during the same time period. The median follow-up period was 16.7 months. During the follow-up period, instances of delayed bleeding and recurrent pharyngitis were monitored. Results: In comparison to the patients who underwent ECT, the PIT group showed significantly fewer cases of postoperative bleeding (p = 0.027). Thirteen patients in the PIT group (1.5%) visited the hospital during the follow-up period for pharyngitis, while 8 in the ECT group (4.2%) visited for pharyngitis. The mean postoperative pain score, as assessed by a VAS, was 4.6 ± 3.2, and pain improved within an average of 2.9 days after surgery in the PIT group. The mean KOSA-18 score for the QOL of the patients was 65.9 preoperatively and 35.6 postoperatively in the PIT group. Conclusions: Pediatric tonsillectomy using PIT is valid for reducing postoperative pain and improving the QOL of OSA patients. PIT is also effective and safe for patients with a history of recurrent tonsillitis.

Comparison of three tonsillectomy techniques in children.

Tonsillectomy is still one of the most common surgical procedures worldwide performed by otorhinolaryngologists. This single-blind randomized study aimed to compare cold dissection tonsillectomy, coblation tonsillectomy, and harmonic scalpel tonsillectomy in pediatric patients in respect of intraoperative blood loss, operating time, and postoperative pain and bleeding. This single-blind randomized clinical trial evaluated 82 pediatric patients aged 3-16years (mean age: 7.23 ± 3.26years) applied with tonsillectomy between April 2017 and March 2020. Harmonic scalpel tonsillectomy was applied to 33 (40.2%) patients, the cold knife technique to 25 (30.5%), and coblation tonsillectomy to 24 (29.3%). There was no statistically significant difference between the three techniques in respect of postoperative pain levels and post-tonsillectomy bleeding rates. The intraoperative bleeding rate and mean operating time were determined to be significantly lower in the harmonic scalpel group (p < 0.05). Harmonic scalpel tonsillectomy is associated with a shorter operating time and lower intraoperative bleeding rates and similar postoperative pain score and postoperative bleeding rates compared with coblation tonsillectomy and cold dissection tonsillectomy. Harmonic scalpel tonsillectomy is a fast, safe, and effective method for tonsillectomy in children.

Coblation intracapsular tonsillectomy in pediatric patients

Introduction: Intracapsular tonsillectomy is a relatively new technique with the potential to replace the traditional total tonsillectomy approach. While there have been many studies describing the benefits of intracapsular tonsillectomy is over total tonsillectomy, there is limited literature detailing the actual technique and nuances behind the intracapsular operation, particularly using coblation. This report aims to describe in detail the intracapsular tonsillectomy technique performed at our institution and provide insight on how to approach common issues. Methods: Intracapsular tonsillectomy was performed using a coblator to remove tonsillar tissue down to the capsule, preserving nerve endings and most vasculature. Results: Coblation intracapsular tonsillectomy is an elegant and easy-to-learn technique. Discussion: Intracapsular tonsillectomy is a powerful technique which has become the gold standard at our institution. This article details the basic technique as well as nuances of coblation intracapsular tonsillectomy.

Intraoperative intravenous ibuprofen use is not associated with increased post-tonsillectomy bleeding

ObjectivesIntravenous (IV) ibuprofen was approved by the FDA for use in pediatric patients in November 2015. The objective of this study was to compare bleeding rates in pediatric tonsillectomy patients who received intraoperative intravenous ibuprofen versus those who did not. Secondary objectives included analyzing factors that correlated with return to the Emergency Department (ED) for pain or dehydration. MethodsCharts were reviewed for all patients 0–18 years of age who underwent a tonsillectomy with or without adenoidectomy at a tertiary care children's hospital from 1/1/2017 through 5/21/2018. Demographic information and perioperative medications including the use of intraoperative intravenous ibuprofen were recorded. ED visits and operating room (OR) returns for bleeding were tracked for up to 30 days after surgery. Results1085 charts were analyzed. Intraoperative IV ibuprofen was used in 132 cases (12.2%). Primary bleeds, defined as bleeding within 24 h of surgery, occurred in 1 (0.76%) of 132 patients who received IV ibuprofen, and 1 (0.10%) of 953 patients who did not receive IV ibuprofen. Secondary bleeds, defined as bleeds after 24 h from surgery occurred in 2 (1.52%) of 132 patients who received IV ibuprofen and 38 (3.99%) of 953 patients who did not receive IV ibuprofen. No statistical difference was found between the two groups in rates of overall (primary plus secondary) bleeding requiring return to ED (p = 0.759) or return to OR (p = 0.710). ConclusionThe observed bleeding rate after pediatric tonsillectomy was not statistically different in patients who received intraoperative IV ibuprofen versus those who did not receive this medication. Level of evidenceIII.

Bipolar Radiofrequency (RF) in Pediatric Tonsillectomy: A Prospective Controlled Study

Background/Hypothesis: Tonsillectomy operation is one of the most frequently performed procedures in otolaryngology practice. Many tonsillectomy techniques have been used as a trial to improve post-operative results especially those related to pain and bleeding. We aimed to assess safety of bipolar radiofrequency tonsillectomy in pediatric patients, comparing its results with the classic cold steel technique. Study Design: Prospective controlled study. Methods: Two hundred cases were included in this study. They were placed into 2 groups which underwent tonsillectomy by 2 different techniques with comparison between the results of both groups. Results: Bipolar radiofrequency had a better result regarding time of the operation and intra-operative bleeding with similar results regarding post-operative pain and follow up. Conclusion: Bipolar radiofrequency is an effective and safe technique in total tonsillectomy with acceptable intra-operative and post-operative results regarding pain and bleeding and can be used in pediatric population with no major morbidities.

Comparison of coblation tonsillectomy and bipolar tonsillectomy in pediatric patients

Amaç: Tonsillektomi ameliyat sonrası ağrı şiddeti fazla olan ve çocuk hastalarda sık uygulanan cerrahi bir işlemdir. Bu çalışmada koblasyon ve bipolar teknikle tonsillektomi yapılan çocuk hastalarda ameliyat süresinin ve ameliyat sonrası ağrı ve gelişen komplikasyonların karşılaştırılması amaçlandı.Materyal ve Metod: Bu retrospektif çalışmaya yaşları 5-13 arasında değişen koblasyon (n=37) ve bipolar (n=41) diseksiyon teknikleri kullanılarak Mayıs 2018 ve Nisan 2019 tarihleri arasında total tonsillektomi yapılan toplam 78 hasta dahil edildi. Gruplar arasında ameliyat süresi, ameliyat sonrası ağrı şiddeti ve komplikasyonlar karşılaştırıldı.Bulgular: Ortalama ameliyat süresi koblasyonton sillektomi yapılan grupta bipolar tonsillektomi yapılan gruba göre anlamlı derecede uzundu (p&amp;lt;0.001). Koblasyon tonsillektomi sonrası ağrı ameliyat sonrası birinci (p&amp;lt;0.001), ikinci (p=0.019) ve üçüncü (p=0.041) günlerde bipolar tonsillektomi sonrası ağrı ile kıyaslandığında anlamlı derecede daha azdı. Ameliyat sonrası kanama bipolar tonsillektomi grubuna kıyasla koblasyon tonsillektomi grubunda daha az sıklıkta gözlendi (p=0.034). Sonuç: Çocuklarda koblasyon tonsillektomi bipolar tonsillektomiye kıyasla daha uzun ameliyat sürelerine ve daha fazla maliyete rağmen ameliyat sonrası daha az ağrı ve morbiditeyle ilişkili son derece güvenli bir tekniktir.

Could digital photography be an alternative to postoperative physical examination for pediatric tonsillectomy patients?

ObjectiveTo evaluate and compare the efficacy of postoperative control with digital photographs and physical examination for children who underwent tonsillectomy? MethodsIn this prospective study, 86 children (46 boys (53.5%) and 40 girls (46.5%) were enrolled for postoperative clinical visit and for obtaining photographs of the tonsillar bed with a digital camera at clinic control. ResultsNo difference in tonsillar fossa healing was observed between the two methods 2 weeks after surgery. ConclusionsDigital photographs proved to be a safe method for postoperative control of pediatric patients who underwent tonsillectomy. Adding control with outpatient follow-up will be useful for minimizing postoperative complications.

Perioperative interdisciplinary approach for reduction of opioid use in pediatric tonsillectomy: Protocol using dexmedetomidine and bupivicaine as adjunct agents.

Pediatric tonsillectomy is a common procedure now being performed most often for patients with obstructive sleep apnea, which has been associated with increased sensitivity to the respiratory side effects of opioid medications. This study investigates a strategy to decrease the use of opiate medications in a particularly vulnerable population. Describe an interdisciplinary approach between Otolaryngologists and Anesthesiologists to decrease opiate use in tonsillectomy patients. Demonstrate safety of this protocol. Evaluate the effect of the protocol on intraoperative need for opiate medications and inhaled anesthetic use. Perform cost analysis of the protocol. Retrospective case-control study with cost analysis. Tertiary Care Hospital. Pediatric patients undergoing tonsillectomy at a tertiary care hospital. Preoperative and intraoperative dexmedetomidine with local bupivacaine injection into the tonsillar fossa. Intraoperative need for sevoflurane, opiate, and propofol. Post-operative pain scores, and utilization of post-operative opiate, acetaminophen, and ibuprofen pain medications. Post-operative adverse events. Cost analysis of protocol. This protocol led to a decrease in intraoperative opiate use by 49.6%, a decrease in intraoperative sevofluorane use by 18%, and a lower reported maximum post-operative pain score without any increase in adverse events. The protocol added a small increase in medication cost of $4.07 to each procedure. The use of dexmedetomidine and local anesthetic in pediatric tonsillectomy is a safe and effective protocol that allows for the reduction of opiate use and improved post-operative pain control. Question: Can the combination of dexmedetomidine and infiltration of local anesthetic reduce overall opioid use for peediatric patients undergoing tonsillectomy? In this case-control study, use of dexmedetomidine and local anesthetic injected into the tonsillar fossa led to a decrease in intraoperative opiate use by 49.6%, a decrease in intraoperative sevofluorane use by 18%, and a lower reported maximum pain score without an increase in adverse events. Meaning: Use of dexmedetomidine and local anesthetic as anesthetic adjuncts may help reduce need for intraoperative opiates and decrease the use of volatile anesthetic agents in pediatric tonsillectomy patients, which are undesirable medications in the pediatric population for their respective respiratory depression and potentially neurotoxic side effects.

The impact of platelet-rich plasma therapy on short-term postoperative outcomes of pediatric tonsillectomy patients.

To compare the short-term outcomes of pediatric patients who underwent tonsillectomy alone vs. tonsillectomy plus platelet-rich plasma (PRP) therapy in terms of postoperative pain, appetite status, analgesia requirement, and bleeding complications. This study included a total of 80 pediatric tonsillectomy patients (53.8% female, 46.2% male, aged 4-16years), who were randomly allocated into tonsillectomy alone (TA group; n = 40) and tonsillectomy plus PRP therapy (TPRP group, n = 40) groups. Patient demographic data (age, gender) and postoperative data of visual analog scale (VAS) pain scores (postoperative 2nd hour, 1-10days), appetite scores (postoperative 1-7days), and analgesia requirement (postoperative 1-10days) and bleeding complications were recorded. A significant gradual decrease was noted in pain scores starting from the 3rd postoperative day reaching 0.0 ± 0.0 and 0.50 ± 0.88 on Day 10 in the TPRP and TA groups, respectively (p < 0.001 for each). Compared to the TA group, the TPRP group was associated with significantly lower pain scores (Day 1 to Day 10), better appetite scores (Day 1 to Day 6), a lower requirement for analgesia (Day1 to Day 10) and fewer common bleeding complications (1 vs. 4 patients) in the postoperative period (p < 0.001 for each). In conclusion, this study of pediatric tonsillectomy patients revealed the superiority of tonsillectomy with PRP over tonsillectomy alone in terms of effectiveness in reducing post-tonsillectomy pain and improving appetite status, together with a lower requirement for analgesia and a reduced risk of post-tonsillectomy bleeding during the first 10 postoperative days.

Gross Pathology of Routine Pediatric Tonsillectomy Specimens: Optimizing the Value of Patient Care.

This investigation seeks to evaluate the effect of gross pathologic analysis on our management of patients undergoing routine tonsillectomy and to evaluate charges and reimbursement. Retrospective chart review from 2005 through 2016. Academic medical center. Participants were pediatric patients aged 14 years and younger undergoing tonsillectomy for either sleep-disordered breathing or tonsillitis, with tonsillectomy specimens evaluated by pathology, and without any risk factors for pediatric malignancy. Records were reviewed for demographics, surgical indications, and pathology. Abnormal reports prompted an in-depth review of the chart. Charges and reimbursement related to both hospital and professional fees for gross tonsil analysis were evaluated. From 2005 to 2016, 3183 routine pediatric tonsillectomy cases were performed with corresponding specimens that were sent for gross analysis revealing no significant pathologic findings; 1841 were males and 1342 were females. Ten cases underwent microscopy by pathologist order, revealing normal tonsillar tissue. The mean charge per patient for gross analysis was $60.67 if tonsils were together as 1 specimen and $77.67 if tonsils were sent as 2 separate specimens; respective reimbursement amounts were $28.74 and $35.90. Gross pathologic analysis did not change our management of routine pediatric tonsillectomy patients. Foregoing the practice at our institution would eliminate $19,171.72 to $24,543.72 in charges and $9081.40 to $11,344.40 in reimbursement per year. Eliminating this test would improve the value of patient care by saving health care resources without compromising clinical outcomes.