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Bagher SM, Bhadila GY, Alqahtani NH, Alharbi NH, Felemban OM. The use of DryShield versus rubber dam isolation systems among pediatric patients with different airway patency: A randomized clinical trial. Saudi Dent J 2024; 36:873-879. [PMID: 38883897 PMCID: PMC11178952 DOI: 10.1016/j.sdentj.2024.03.013] [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] [Received: 11/27/2023] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 06/18/2024] Open
Abstract
Objectives This randomized clinical trial aimed to evaluate the impact of DryShield isolation (DSI) and rubber dam isolation (RDI) system usage on vital signs, behavior, pain and discomfort, and chairside time required among children with different airway patencies based on the Modified Mallampati Classification (MMC). Material and methods Healthy, cooperative children who required fissure sealant in at least two contralateral, fully erupted, permanent first molars were included. Airway patency was determined by two trained and calibrated dentists using the MMC. The participants were categorized based on their MMC scores into patent airways (classes I and II) and non-patent airways (classes III and IV). The dental procedure was videotaped during treatment, and vital signs, including arterial oxygen saturation, heart rate, and blood pressure, were recorded every 3 min. The participants' subjective pain and discomfort were evaluated using a previously validated Arabic interview questionnaire and a validated Arabic version of the Wong-Baker Faces Pain Rating Scale. The participants' behavior and behavioral pain were evaluated utilizing the Frankl Behavior Scale and the face, legs, activity, cry, and consolability scales, respectively. Results There were no significant differences in any of the vital signs between DSI and RDI. DSI use yielded a significant reduction in chairside time (P < 0.001) and was more bothersome (P < 0.001) than RDI use among all participants, regardless of airway patency. DSI was associated with significantly better behavior during the dental procedure (P = 0.002) and less behavioral pain (P < 0.001) among all participants, regardless of airway patency. Conclusion Irrespective of airway patency, DSI outperformed RDI in terms of behavior, pain, and procedure duration; however, DSI was characterized by noise, pressure on soft tissues, and an increased tendency to induce gag reflexes.
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Affiliation(s)
- Sara M Bagher
- Faculty of Dentistry, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Ghalia Y Bhadila
- Faculty of Dentistry, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Njood H Alqahtani
- Faculty of Dentistry, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Njood H Alharbi
- Faculty of Dentistry, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Osama M Felemban
- Faculty of Dentistry, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
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Feng B, Guo Y, Tang S, Zhang T, Gao Y, Ni X. Association of preoperative neutrophil-lymphocyte ratios with the emergence delirium in pediatric patients after tonsillectomy and adenoidectomy: an observational prospective study. J Anesth 2024; 38:206-214. [PMID: 38267728 DOI: 10.1007/s00540-023-03303-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/17/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE The study aimed to investigate potential risk factors for emergence delirium (ED) in pediatric patients after tonsillectomy and adenoidectomy (T&A). METHODS This prospective, single-center observational study enrolled children aged 3-7 years who underwent T&A under general anesthesia. ED was assessed according to DSM-IV or V criteria. Receiver operating characteristic curve analysis was performed to evaluate the predicative and cut-off values of risk factors, including age, preoperative anxiety level, postoperative pain and neutrophil-lymphocyte ratio (NLR) for ED. Univariate and multivariate logistic regression analyses were performed to investigate risk factors for ED. RESULTS 94 pediatric patients who underwent T&A were enrolled and 19 developed ED (an incidence of 25.3%). Receiver operating characteristic analysis indicated that preoperative NLR was a significant predictor of ED with a cut-off value of 0.8719 and an area under the curve (AUC) of 0.671 (95% confidence interval (CI) 0.546-0.796, P = 0.022). Preoperative NLR (< 0.8719) and postoperative pain were independent risk factors associated with ED (odds ratio: 0.168, 95% CI 0.033-0.858, P = 0.032; odds ratio: 7.298, 95% CI 1.563-34.083, P = 0.011) according to multivariate logistic regression analysis. CONCLUSIONS Preoperative NLR level and postoperative pain were independent risk factors for ED in pediatric patients undergoing T&A.
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Affiliation(s)
- Bei Feng
- Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804, Shengli South Street, Xingqing District, Yinchuan, 750004, China
| | - Yuhao Guo
- Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804, Shengli South Street, Xingqing District, Yinchuan, 750004, China
| | - Shaling Tang
- Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804, Shengli South Street, Xingqing District, Yinchuan, 750004, China
| | - Tie Zhang
- Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804, Shengli South Street, Xingqing District, Yinchuan, 750004, China
| | - Yubo Gao
- Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804, Shengli South Street, Xingqing District, Yinchuan, 750004, China.
| | - Xinli Ni
- Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804, Shengli South Street, Xingqing District, Yinchuan, 750004, China.
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Kourelis K, Marazioti A, Kourelis T, Stathopoulos GT. Haematologic Markers and Tonsil-to-Body Weight Ratio to Assist Adenotonsillar Hypertrophy Diagnosis. Indian J Otolaryngol Head Neck Surg 2022; 74:5604-5610. [PMID: 36742935 PMCID: PMC9895696 DOI: 10.1007/s12070-021-02943-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Aims Diagnosis of Adenotonsillar Hypertrophy (ATH), the leading cause of pediatric Obstructive Sleep Apnea (OSA), depends on physical exam via Brodsky's staging of tonsils. This study investigates the associations of ATH with patient parameters, and balances in-office tonsil hypertrophy appraisal against true organ mass. Materials and Methods A prospective cohort was formed of 103 children operated for ATH, and 31 matched controls. Demographic, clinical and tympanographic data, as well as Complete Blood Count (CBC) indices were compared. Absolute and relative to total body weight tonsil specimen mass were correlated with Brodsky's score. Results Tonsillar size indices were significantly raised in ATH patients. Elevated leukocytes (P = 0.012) and increased neutrophil percentage (P = 0.025) conveyed higher ATH risk. Subjective evaluation of tonsils graded 1 or 2 correlated significantly with absolute (P = 0.001) and relative (P = 0.006) objective measurements. Brodsky's score 3 and 4 displayed marginal significant association with relative (P = 0.050) but not with true (P = 0.989) mass. Conclusion An occult hematologic inflammatory response was detected in ATH children. Clinical estimation of severely hypertrophic tonsils should be adjusted for total body weight. Trial Registration Number: NCT03541434 (clinicaltrials.gov).
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Affiliation(s)
- Konstantinos Kourelis
- Department of Otolaryngology, Children’s Hospital of Patras “Karamandaneio”, Erythrou Stavrou 40 Str., 26331 Patras, Achaia Greece
| | - Antonia Marazioti
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, Biomedical Sciences Research Center, University of Patras, 1 Asklepiou Str., University Campus, 26504 Rio, Achaia Greece
| | - Theodoros Kourelis
- Department of Medical Oncology, “Olympion” General Hospital, Volou & Meilichou Str., 26443 Patras, Achaia Greece
| | - Georgios T. Stathopoulos
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, Biomedical Sciences Research Center, University of Patras, 1 Asklepiou Str., University Campus, 26504 Rio, Achaia Greece
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Zeng GH, Xu G, Liu HY, Gao Z. Association between mean platelet volume and obstructive sleep apnea-hypopnea syndrome in children. Medicine (Baltimore) 2022; 101:e31505. [PMID: 36316893 PMCID: PMC9622644 DOI: 10.1097/md.0000000000031505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
To evaluate the correlation between mean platelet volume (MPV) and obstructive sleep apnea-hypopnea syndrome (OSAHS) in children, and to explore the diagnostic value of MPV for OSAHS. Children with OSAHS diagnosed by polysomnography (PSG) at Fuyong People's Hospital of Bao'an District/Shenzhen Children's Hospital from January 2020 to January 2021 were enrolled in this study. MPV in peripheral venous blood of the enrolled children was detected. Based on the PSG results (apnea-hypopnea index [AHI] and lowest oxygen saturation [LSaO2]), illness severity was classified, and correlations between the 2 parameters were statistically analyzed. A total of 190 children (males = 135, females = 55) with OSAHS were enrolled in the study. There were no significant correlations between AHI, LSaO2, white blood cell count, red blood cell count, blood platelets, hemoglobin, and packed cell volume (P > .05), but there was a significant positive correlation between AHI and MPV (R > 0, P < .05). There was a significant negative correlation between the LSaO2 index and MPV (R > 0, P < .05). In addition, the receiver operating characteristic (ROC) curve indicated that the best cutoff value for MPV to diagnose mild and moderate-to-severe disease conditions was 9.35 fl, and the coincidence rates for these 2 disease conditions were 93% and 80%, respectively. The ROC curve was also optimal for the diagnosis of mild and moderate-to-severe hypoxia. The critical value was 8.85 fl, and the coincidence rates for these 2 conditions were 96.4% and 76.3%, respectively. In children with OSAHS, MPV is positively correlated with AHI and negatively correlated with the LSaO2 index of PSG. Based on the results of ROC curve analysis, MPV can be used as an auxiliary diagnostic index to judge the severity of OSAHS and the degree of hypoxia in children.
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Affiliation(s)
- Guo-hui Zeng
- Department of Ophthalmology, Fuyong People’s Hospital, Baoan District, Shenzhen, China
- *Correspondence: Guo-hui Zeng, Department of Ophthalmology, Fuyong People’s Hospital, NO. 81 Defeng Road, Baoan District, 518103, Shenzhen, Guangdong, China (e-mail: )
| | - Guo Xu
- Department of Ophthalmology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Hong-yu Liu
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zhong Gao
- Department of Ophthalmology, Fuyong People’s Hospital, Baoan District, Shenzhen, China
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Chang WD, Tseng CH, Tsou YA. Mean platelet volume levels in children with sleep-disordered breathing: a meta-analysis. BMC Pediatr 2020; 20:204. [PMID: 32393268 PMCID: PMC7212570 DOI: 10.1186/s12887-020-02099-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pediatric sleep-disordered breathing (SDB) correlated with respiratory conditions of snoring and hypopnea. Mean platelet volume (MPV) was an inflammatory marker, related to increased inflammatory condition of pediatric patients. Increase of MPV level may cause failure to thrive or increased upper airway infection rate. The aim of this study was to perform systematic review and meta-analysis to investigate the difference on MPV values for pediatric SDB, and compare the change on MPV after surgery in patients with pediatric SDB. METHODS A systemic review of the studies from PubMed, EMBASE, and Cochrane Library databases was conducted in March 2020, supported by reviewing of published articles for studies comparing MPV in pediatric SDB. Meta-analysis was used to compare the change of MPV in pediatric SDB, and sub-group analysis was also used to compare the MPV decrease after surgeries of adenoidectomy or adenotonsillectomy. RESULTS There were seven studies included in the review. Six of them including 963 subjects showed that a significant increase of MPV was noted in pediatric SDB compared to those in pediatric non-SDB (P < 0.05). Total standardized mean difference (SMD) in MPV between pediatric SDB and non-SDB was 0.51 (95% CI =0.30-0.72, P < 0.05). A significant decrease of MPV was found in pediatric SDB patients who underwent surgery (total SMD = - 0.36; 95% CI = - 0.70- -0.02, P < 0.05). Decreases of MPV after adenoidectomy and adenotonsillectomy were observed, but only the effect of adenotonsillectomy had a statistical significance (total SMD = - 0.72; 95% CI = - 1.18 - -0.26, P < 0.05). CONCLUSION The MPV was significantly higher in patients with pediatric SDB, indicating the presence of increased platelet activity in pediatric SDB patients. The level of MPV could be reduced by the two surgeries, especially adenotonsillectomy.
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Affiliation(s)
- Wen-Dien Chang
- Department of Sport Performance, National Taiwan University of Sport, Taichung, Taiwan
| | - Chih-Hao Tseng
- Clinical Laboratory, Cheng-Ching General Hospital, Taichung, Taiwan.
| | - Yung-An Tsou
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan. .,Department of Audiology and Speech-Language Pathology, Asia University, No. 91, Hsueh-Shih Road, Taichung, Taiwan.
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Lee SY, Kim JW. Nasopharyngeal Width and Its Association With Sleep-Disordered Breathing Symptoms in Children. Clin Exp Otorhinolaryngol 2019; 12:399-404. [PMID: 30832459 PMCID: PMC6787469 DOI: 10.21053/ceo.2018.01151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 12/26/2018] [Indexed: 01/07/2023] Open
Abstract
Objectives Although adenotonsillar hypertrophy is the main cause of sleep-disordered breathing in children, surrounding anatomic factors, such as the width of the nasopharynx, can affect upper airway patency. However, there have been no reports of the association of nasopharyngeal width with sleep-disordered breathing in children. This study was undertaken to measure nasopharyngeal width in children undergoing adenotonsillectomy for sleep-disordered breathing and to investigate the clinical implications of this factor. Methods This was a retrospective study with a follow-up period of 1 year, performed at a tertiary referral center. We reviewed the operative records of children who underwent adenotonsillectomy at our center for symptoms of sleep-disordered breathing, such as snoring, apnea, and mouth breathing. The nasopharyngeal width was measured immediately before adenotonsillectomy, which was performed under general anesthesia with a microscopy-assisted mirror view. Adenotonsillar hypertrophy was graded on a four-point scale, and symptoms of sleep-disordered breathing were evaluated by using the Korean version of the Obstructive Sleep Apnea-18 questionnaire before and after surgery. The relationships between the average nasopharyngeal width and patient age and sex, adenotonsillar hypertrophy, and the Korean version of the Obstructive Sleep Apnea-18 score were analyzed. Results The study included 549 children (343 boys) with a mean age of 6.0 years (range, 2 to 11 years). The average nasopharyngeal width was 11.9 mm (range, 7.0 to 18.0 mm) and increased with age (range, 11.2 to 13.3; β=0.264; P<0.001). At 1 year after surgery, children with a greater nasopharyngeal width at the time of surgery exhibited additional improvements in symptoms of obstruction relative to those at 1 month after surgery. Conclusion The average nasopharyngeal width in children is approximately 11.9 mm and exhibits a slight increase with age. The width of the nasopharynx may be a factor associated with the degree of improvement in symptoms of sleep-disordered breathing after adenotonsillectomy.
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Affiliation(s)
- Sang-Youp Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Cardiopulmonary functions and adenotonsillectomy: surgical indications need revision. The Journal of Laryngology & Otology 2016; 130:1120-1124. [PMID: 27786148 DOI: 10.1017/s0022215116009129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess cardiac functions in adenotonsillar or tonsillar hypertrophy. METHODS A prospective, interventional, academic centre based study was conducted on 25 children with adenotonsillar or tonsillar hypertrophy. All patients underwent pulsed 2-dimensional Doppler echocardiography, pulse oximetry and 12-lead electrocardiography. These assessments were repeated three months later to determine the impact of adenotonsillectomy. RESULTS There were significant differences in mean arterial oxygen saturation, pulmonary flow acceleration time and mean pulmonary artery pressure post-operatively. Adenotonsillectomy led to significant improvements in pulmonary flow acceleration time and pulmonary flow velocity time index, while tonsillectomy resulted in right ventricular early and late diastolic velocity index improvement. CONCLUSION Upper airway obstruction in children affects cardiac functioning and this can subsequently lead to morbidity and delayed growth. Hence, revision of surgical indications is advocated in adenotonsillar hypertrophy to avoid irreversible damage to cardiopulmonary functions.
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