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Felemban WA, Alhussaini R, Essa AF, Felemban AA, Fallatah JM. Knowledge and Awareness Among Parents of Pediatric Patients Regarding the Complications of Recurrent Adenotonsillitis and Its Surgical Treatment. Cureus 2021; 13:e20402. [PMID: 34926095 PMCID: PMC8671063 DOI: 10.7759/cureus.20402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Given that parents act as both decision-makers and caregivers for their children, focusing on their experiences in managing their child's complex postoperative recovery is important. Objective To evaluate the parents' awareness regarding adenotonsillar diseases and post-adenotonsillectomy complications in their children. Methods This was a cross-sectional descriptive study involving parents and guardians of pediatric patients aged 1-14 years scheduled to undergo adenotonsillectomy according to Paradise Criteria at Ohud Hospital, Al Madinah. A well-constructed, self-administered questionnaire, including questions regarding sociodemographic characteristics and those assessing the knowledge of parents/guardians regarding adenotonsillar diseases and post-adenotonsillectomy complications, was distributed to all participants. Results This study included 294 parents (mean ± standard deviation of age, 33.0 ± 6.9 years; range, 18 and 55 years), more than half of whom were males (153, 52%). Overall, 127 parents (43.2%) had a poor level of knowledge regarding the complications of recurrent adenotonsillitis and its surgical treatment. University/postgraduate parents were more knowledgeable than lower educated parents (p < 0.001). Participants with a family history of recurrent adenotonsillectomy were more knowledgeable than those who had no such history (p < 0.001 ). Conclusion The parents/guardians of children scheduled to undergo adenotonsillectomy had insufficient knowledge regarding the complications of recurrent adenotonsillitis and its surgical treatment, necessitating health education among such a demographic.
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Affiliation(s)
- Walaa A Felemban
- Otolaryngology-Head and Neck Surgery, Ohud Hospital, Medina, SAU
| | - Rayan Alhussaini
- Otolaryngology-Head and Neck Surgery, Prince Mohammed Bin Abdulaziz Hospital, National Guard Health Affairs, Medina, SAU
| | - Abdullah F Essa
- Family Medicine, Prince Mohammed Bin Abdulaziz Hospital, National Guard Health Affairs, Medina, SAU
| | - Alaa A Felemban
- Family Medicine, Eastern al-Jarf Primary Healthcare Center, Medina, SAU
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Marinho S, Frias P, Oliveira I, Silva R, Rodrigues F, Paiva A. Subcutaneous emphysema as a complication of the use of a laryngeal mask in a child. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2020; 67:212-214. [PMID: 32178913 DOI: 10.1016/j.redar.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/30/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
The use of supraglottic airway devices has been increasing in popularity, mostly due to their high success rate and low complications. However, there is very little information available about the potential and group specific concerns regarding their use in children. We present the first description of a child that developed subcutaneous emphysema after the use of a laryngeal mask. We believe that more awareness to the risk of perioperative adverse events with laryngeal mask insertion in the paediatric population is needed.
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Affiliation(s)
- S Marinho
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal.
| | - P Frias
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - I Oliveira
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - R Silva
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - F Rodrigues
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - A Paiva
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
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Kim HJ, Kim MS, Kim HY, Park WK, Kim WS, Kim S, Kim HJ. Effect of Timing of Intravenous Fentanyl Administration on the Incidence of Posttonsillectomy Nausea and Vomiting. Laryngoscope 2020; 130:2900-2905. [PMID: 31985080 DOI: 10.1002/lary.28533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/29/2019] [Accepted: 01/09/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE/HYPOTHESIS Fentanyl is commonly administered toward the end of tonsillectomy to prevent emergence delirium and reduce postoperative pain. However, it can delay emergence from anesthesia and increase the risk of postoperative nausea and vomiting (PONV). The goal of our study was to compare the risk of PONV based on the timing of fentanyl administration at the end of tonsillectomy in children. STUDY DESIGN Prospective, double-blind, randomized controlled trial. METHODS One hundred forty patients aged 3 to 7 years undergoing tonsillectomy were divided into two groups. Fentanyl (1 μg/kg) was administered at the end of surgery in group 1 (n = 70) and at 10 to 15 minutes before the end of surgery in group 2 (n = 70). Time to regular breathing and time to emergence from anesthesia were measured from the end of surgery. PONV and pediatric anesthesia emergence delirium scale scores were assessed every 10 minutes after admission to the postanesthesia care unit. RESULTS Incidences of PONV (2.9% vs. 2.9%, P > .99) and emergence delirium (11.4% vs. 5.7%, P = .23) were not significantly different between the two groups. Time to regular breathing (mean difference = 2.3 minutes; 95% confidence interval [CI]: 0.9 to 3.7 minutes) and time to emergence (median difference = 6.5 minutes; 95% CI, 2.5 to 10.5 minutes) were significantly longer in group 1 than in group 2. CONCLUSIONS Although there was no beneficial effect on PONV, recovery of regular breathing and consciousness was quicker with earlier fentanyl administration. Emergence delirium was well-controlled, similar to that with fentanyl administration at the end of surgery. LEVEL OF EVIDENCE 1b Laryngoscope, 2020.
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Affiliation(s)
- Hye Jin Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min-Soo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wyun Kon Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Shik Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sungmi Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Joo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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In W, Kim YM, Kim HS, Hong S, Suh Y, Cha Y, Kim N, Kim J, Kang H, Kwon H, Kim Y, Park W. The Effect of a Parental Visitation Program on Emergence Delirium Among Postoperative Children in the PACU. J Perianesth Nurs 2018; 34:108-116. [PMID: 30005899 DOI: 10.1016/j.jopan.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/31/2018] [Accepted: 04/07/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to examine the effects of parental presence on the incidence of emergence delirium (ED) of children in the postanesthesia care unit (PACU). DESIGN A quasi-experimental pretest and post-test study with nonequivalent and nonsynchronized control groups. METHODS About 93 children aged 3 to 6 years undergoing general anesthesia for tonsillectomy were divided into two groups: parental presence and absence. ED was recorded using the Pediatric Anesthesia Emergence Delirium Scale at 0, 10, 20, and 30 minutes after PACU admission. FINDINGS ED score at each time point in the experimental group was lower than the control group, but not statistically significant. ED score in the experimental group significantly decreased over time (F = 6.98; P = .010). CONCLUSIONS Parental visitation programs could be effective on the degree of ED in children in the PACU setting. This result may contribute to the establishment of PACU visitation program policy in South Korea.
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Abstract
Adenotonsillectomy remains one of the most common surgical procedures carried out in children. Though a commonly performed procedure, it poses a great challenge to the surgeon as well as the anaesthesiologist and is associated with a substantially increased risk of morbidity and mortality. In the post-operative period, it poses threats such as post-tonsillectomy bleeding and airway obstruction if not diagnosed and treated promptly. Various recent advances in airway management and early detection of post-operative complications have been made to reduce the sequelae associated with tonsillectomy. In this article, we have reviewed the various techniques, complications and recent advances, which have evolved in the anaesthetic technique related to adenotonsillectomy.
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Affiliation(s)
- Anand Bangera
- Department of Anaesthesiology, K.S. Hegde Medical Academy, Mangalore, Karnataka, India
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Goh SY, Thong SY, Chen Y, Kong AS. Efficacy of intubation performed by trainees on patients in the lateral position. Singapore Med J 2015; 57:503-6. [PMID: 26768062 DOI: 10.11622/smedj.2015165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Anaesthetists may be called upon to emergently secure the airway of a laterally positioned patient. Intubating a patient's trachea in the lateral position may be difficult due to unfamiliarity. This exploratory study aimed to investigate the success rate of lateral intubation performed by novices in a controlled setting. METHODS In this observational study, all patients who presented for elective surgery requiring the lateral position with planned lateral intubation at Singapore General Hospital were included. The trainee assigned to each patient had no prior indication of the proposed lateral intubation until the start of the case. Verbal instructions were given before the start of and during the procedure. The consultant anaesthetist in attendance could intervene at any point to prevent patient harm or if the trainee requested assistance. Time to intubation, adjuncts used and complications encountered were recorded. RESULTS A total of 44 consecutive patients were included in this study. The trainees completed 42 of the 44 lateral intubations, with 41 being successfully performed on the first attempt. All patients were intubated successfully in a lateral position within two attempts. The mean duration of intubation was 57.3 ± 36.4 seconds. There was no difference between left and right lateral intubation. Other than one episode of transient desaturation on pulse oximetry, there were no complications. CONCLUSION Lateral intubation by trainees had a high success rate when supervised by an experienced operator. Intubation of patients in unconventional positions using routine airway equipment should be included in airway training for trainees.
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Affiliation(s)
- Sin Yee Goh
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Sze Ying Thong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Yufan Chen
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Andrew Seun Kong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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Faiz SHR, Rahimzadeh P, Alebouyeh MR, Sedaghat M. A Randomized Controlled Trial on Analgesic Effects of Intravenous Acetaminophen versus Dexamethasone after Pediatric Tonsillectomy. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:e9267. [PMID: 24719693 PMCID: PMC3971785 DOI: 10.5812/ircmj.9267] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 05/02/2013] [Accepted: 05/19/2013] [Indexed: 11/22/2022]
Abstract
Background A few studies are available actually comparing the clinical efficacy of intravenous acetaminophen with other medications such as dexamethasone to inhibit postoperative adverse events in children. Objectives This randomized blinded controlled trial was designed to compare controlling status of postoperative events in children after tonsillectomy randomized to receive either intravenous acetaminophen or dexamethasone. Patients and Methods Eighty four children aged between 4 to 13 undergoing tonsillectomy were randomized using a computer-generated schedule to double-blind treatment with intravenous acetaminophen (15 mg/kg) or intravenous dexamethasone (0.1 mg/kg). Children were post-operatively assessed for swallowing pain, pain while opening mouth, ear pain, and postoperative sore throat in recovery room (within one hour after surgery), at the time of admission to the ward, as well as at 12 and 24 hours after surgery, assessed by the objective pain scoring system (OPS; minimum score: 0 = no pain, maximum score: 10 = extreme pain). Results There were no significant differences between the two groups with regard to the severity of postoperative pain due to swallowing or opening mouth measured at the different study time points from postoperative recovery to 24 hours after the surgery. There was no difference in ear pain severity at the time of postoperative recovery, at the admission time to ward and also at 12 hours after surgery; however mean score of ear pain severity was significantly higher in those who administered acetaminophen 24 hours after operation. Also, the mean score severity of sore throat was significantly higher in the acetaminophen compared with the dexamethasone group within 12 hours of surgery. Postoperative vomiting and bleeding were similarly observed between the two study groups. The severity of swallowing pain, pain while opening mouth, ear pain, as well as postoperative sore throat as gradually assuaged within 24 hours of tonsillectomy in both groups, however no between-group differences were observed in the trend of the severity of these events. Conclusions The dexamethasone-based regimen may have more advantage over the intravenous acetaminophen regimen for inhibiting pain and PONV following tonsillectomy in children.
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Affiliation(s)
- Seyed Hamid Reza Faiz
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
| | - Poupak Rahimzadeh
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
- Corresponding Author: Poupak Rahimzadeh, Rasoul-Akram Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel/fax: +98-2166509059, E-mail: ;
| | - Mahmoud Reza Alebouyeh
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
| | - Minow Sedaghat
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
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Capici F, Ingelmo PM, Davidson A, Sacchi CA, Milan B, Sperti LR, Lorini L, Fumagalli R. Randomized controlled trial of duration of analgesia following intravenous or rectal acetaminophen after adenotonsillectomy in children. Br J Anaesth 2008; 100:251-5. [PMID: 18211998 DOI: 10.1093/bja/aem377] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Doses of acetaminophen 40 mg kg(-1) rectally and 15 mg kg(-1) i.v. produce similar effect-site concentrations. However, the clinical effectiveness of these routes has not been compared. The aim of this study was to compare duration and efficacy of analgesia in children following adenotonsillectomy after acetaminophen either 40 mg kg(-1) rectally or 15 mg kg(-1) i.v. METHODS Fifty children aged between 2 and 5 yr were recruited. They received a standardized anaesthetic, including 2 microg kg(-1) of fentanyl. Children were randomized to receive either rectal or i.v. acetaminophen. Postoperative pain was assessed regularly with the Children and Infants Postoperative Pain Scale score and rescue analgesia provided if scores were 4 or greater. The primary outcome measure was time to first analgesia. Results were plotted with a Kaplan-Meier analysis and median time to rescue analgesia compared between the groups. RESULTS The protocol was successfully completed in 46 children. Forty-five children required rescue medication. The time to first rescue analgesia was longer in children receiving rectal acetaminophen (median 10 h, inter-quartile range 9-11 h) compared with those receiving i.v. acetaminophen (7, 6-10 h) with a P-value of 0.01 by log-rank test for equality in survivor function. Few children in either group required rescue analgesia within the first 6 h with differences between the groups being most prominent in the period from 6 to 10 h. CONCLUSIONS Rectal acetaminophen 40 mg kg(-1) provides longer analgesia for moderately painful procedures when compared with 15 mg kg(-1) acetaminophen i.v.
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Affiliation(s)
- F Capici
- Department of Anaesthesia and Intensive Care, Ospedali Riuniti di Bergamo, Bergamo, Italy
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