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Paediatric day-case tonsillectomy – parent satisfaction questionnaire. The Journal of Laryngology & Otology 2022; 136:654-658. [DOI: 10.1017/s0022215121004357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveTo assess parent or guardian satisfaction with a newly instituted day-case tonsillectomy programme at a tertiary paediatric institution.MethodsAfter receiving ethical approval, an anonymous questionnaire was sent to the parent or guardian of every patient who underwent day-case tonsillectomy between July 2018 and December 2020.ResultsA total of 135 patients were included. The parent or guardian of each patient was sent a questionnaire to be filled in and returned. Ninety-two completed surveys were returned. There were high satisfaction levels, with 91.3 per cent of parents or guardians feeling comfortable bringing their child home, and 92.4 per cent of parents or guardians would recommend day-case tonsillectomy to another parent or guardian. Of the parents or guardians, 10.9 per cent needed to contact healthcare services in the 24 hours following surgery.ConclusionDay-case tonsillectomy has proven to be a safe, efficient service at our institution, with high satisfaction levels from patients and parents or guardians. Areas for improvement focused on communication at the time of discharge regarding follow up and analgesia.
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Grasl S, Mekhail P, Janik S, Grasl CM, Vyskocil E, Erovic BM, Arnoldner C, Landegger LD. Temporal fluctuations of post-tonsillectomy haemorrhage. Eur Arch Otorhinolaryngol 2021; 279:1601-1607. [PMID: 34557959 PMCID: PMC8897317 DOI: 10.1007/s00405-021-07080-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/06/2021] [Indexed: 12/25/2022]
Abstract
Purpose Although haemorrhage is a common and in some cases life-threatening complication after tonsillectomy, surprisingly little is known about the temporal fluctuations of the onset of bleeding. The purpose of this study was to assess circadian and seasonal rhythms of post-tonsillectomy haemorrhage (PTH) and potential ramifications to educate patients and health care staff. Methods This retrospective study carried out at a tertiary referral hospital included paediatric and adult patients requiring emergency surgery due to severe PTH between 1993 and 2019. Medical records were reviewed and patient demographics, details regarding the initial procedure, postoperative day of haemorrhage, and start time of emergency surgery were extracted. Descriptive statistics, Kruskal–Wallis test, Mann–Whitney U test, and Chi-square goodness of fit tests were used to detect potential differences. Results A total of 300 patients with severe PTH and subsequent emergency surgery were identified. The median postoperative duration until PTH was 6 (range: < 1–19) days. 64.7% (n = 194) of all emergency surgeries had to be performed during evening and night hours (6 pm—6 am) (p < 0.0001). Compared to diurnal incidents, the risk of a nocturnal PTH event increased, the longer ago the initial surgery was (p < 0.0001). No seasonal variations were identified. Age, sex, and details of the initial procedure had no significant influence on the start time according to the surgical protocol. Conclusion The discovered temporal fluctuations of PTH are of relevance for patient awareness and preoperative education. Due to possible life-threatening complications, management of severe PTH requires specific resources and trained medical staff on call.
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Affiliation(s)
- Stefan Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Patrick Mekhail
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph M Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Erich Vyskocil
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Boban M Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, Vienna, Austria
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Lukas D Landegger
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria.
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Vyskocil E, Baumgartner WD, Ch. Grasl M, Grasl S, Arnoldner C, Steyrer J, Erovic BM. Post-tonsillectomy hemorrhage: cost-benefit analysis of prolonged hospitalization. Acta Otolaryngol 2020; 140:597-602. [PMID: 32281464 DOI: 10.1080/00016489.2020.1746829] [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] [Indexed: 10/24/2022]
Abstract
Background: Prolonged hospitalization after tonsillectomy up to three nights was implemented to decrease mortality due to post-tonsillectomy hemorrhage.Aims: To assess if extension of postoperative inpatient observation time from one to three nights results in potential benefits following tonsillectomy.Subjects and methods: Patients who stayed only one night post-tonsillectomy between 1994 and 2006 (Group A) were compared to 1570 patients who stayed three nights postoperatively between 2008 and 2016 (Group B). Complication rate and expense of hospitalization were compared.Results: Published data show that 114 (1.78%) out of 6400 patients in group A had post-tonsillectomy hemorrhage. In this patient group 75.4% (n = 86) of all bleedings occurred after discharge from hospital. However, in group B post-tonsillectomy hemorrhage occurred in 70 (4.5%) and of those only 0.38% (n = 6) developed bleeding episodes on the second or third postoperative day (POD). As observed in group A, the majority of hemorrhage (n = 57; 81.4%) was observed after discharge. Cost analysis reveals a difference of approximately 6 million €for all 32 ENT departments per year in Austria.Conclusions and significance: Extending postoperative hospitalization from one to three nights reveals no benefit after tonsillectomy. Comparison reveals substantial increase of costs for an extended 3 nights inpatient stay.
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Affiliation(s)
- Erich Vyskocil
- Department of Otorhinolaryngology, Head Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dieter Baumgartner
- Department of Otorhinolaryngology, Head Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthaeus Ch. Grasl
- Department of Otorhinolaryngology, Head Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Stephan Grasl
- Department of Otorhinolaryngology, Head Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Head Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes Steyrer
- Interdisciplinary Institute for Management and Organisational Behaviour, Vienna, Austria
| | - Boban M. Erovic
- Department of Otorhinolaryngology, Head Neck Surgery, Medical University of Vienna, Vienna, Austria
- Institute for Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
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Zhang Y, Yang Y, Barnard M, Bentley JP, Ramachandran S. Opioid Use for Treatment of Acute Pain Among Children and Adolescents Enrolled in the Mississippi Medicaid Program. J Pharm Pract 2019; 34:558-566. [PMID: 31665970 DOI: 10.1177/0897190019883767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Abuse of opioids among children and adolescents has become a major public concern in the United States. Understanding the epidemiology of opioid use in this vulnerable population is critical to address opioid abuse. OBJECTIVE The aim of this study is to characterize opioid use for the treatment of acute pain among children and adolescents enrolled in Mississippi Medicaid and to determine the effects of related clinical factors (ie, mental health disorders and obstructive sleep apnea [OSA] on patterns of opioid use. METHODS A retrospective cohort study was conducted using the Mississippi Medicaid administrative claims data from October 2015 through December 2017. We examined the proportion of children and adolescents less than 21 years of age using opioids within 7 days following any qualifying acute pain episode, as well as the difference in opioid use patterns between individuals with various demographic and clinical characteristics. RESULTS Over 5% of the eligible population received opioids within 7 days of a qualifying pain episode. The majority received schedule II or schedule III to IV short-acting opioids. There was no significant difference in opioid use for acute pain between individuals with and without a mental health disorder. Opioid use for acute pain was significantly more likely among those with a history of OSA than those without OSA. CONCLUSION This study characterizes the nature and patterns of opioid use among children and adolescents with acute pain. Further research is needed to understand the role of clinical and other demographic factors in the prescribing of opioids for acute pain in this population.
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Affiliation(s)
- Yiqiao Zhang
- Department of Pharmacy Administration, School of Pharmacy, 8083University of Mississippi, MS, USA
| | - Yi Yang
- Department of Pharmacy Administration, School of Pharmacy, 8083University of Mississippi, MS, USA
| | - Marie Barnard
- Department of Pharmacy Administration, School of Pharmacy, 8083University of Mississippi, MS, USA
| | - John P Bentley
- Department of Pharmacy Administration, School of Pharmacy, 8083University of Mississippi, MS, USA
| | - Sujith Ramachandran
- Department of Pharmacy Administration, School of Pharmacy, 8083University of Mississippi, MS, USA
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Lawlor CM, Riley CA, Carter JM, Rodriguez KH. Association Between Age and Weight as Risk Factors for Complication After Tonsillectomy in Healthy Children. JAMA Otolaryngol Head Neck Surg 2019; 144:399-405. [PMID: 29543971 DOI: 10.1001/jamaoto.2017.3431] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance The 1996 Tonsillectomy and Adenoidectomy Inpatient Guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Pediatric Otolaryngology Committee recommended that children younger than 3 years be admitted following tonsillectomy. Recommendations for hospital observation were not included as a key action statement in the 2011 AAO-HNS Clinical Practice Guidelines for Tonsillectomy in Children. Objective To examine the association between posttonsillectomy complication rate and the age and weight of the child at the time of surgery. Design, Setting, and Participants This was a multicenter case series study with medical record review of 2139 consecutive children ages 3 to 6 years who underwent tonsillectomy at 1 tertiary care academic center and 5 acute care centers in New Orleans, Louisiana, between 2005 and 2015. Children with moderate to severe developmental delay, bleeding disorders, and other major medical comorbidities were excluded. Main Outcomes and Measures Complications examined included respiratory distress, dehydration requiring intravenous fluids, and bleeding. Results Of the 2139 patients, 1817 met inclusion criteria. A total of 1011 (55.6%) were male. The mean (SD) age at the time of the procedure was 46 (14) months (range, 12-72 months). The mean weight at the time of the procedure was 17 (5) kg (range, 9-43 kg). A total of 95 patients (5.2%) had a postoperative complication. Of the 455 children younger than 3 years in the study, 32 (7.0%) had complications compared with 63 (4.6%) of the 1362 patients 3 years or older. The odds of having a complication in children younger than 3 years was 1.5 times greater than it was in children 3 years or older (odds ratio [OR], 1.56; 95% CI, 1.00-2.42). When examining total complications, children younger than 3 years were more likely to experience a complication within the first 24 hours after surgery than children 3 years or older (25% vs 9.5%; OR, 3.17; 95% CI, 1.00-10.11). The children admitted to the hospital had a greater risk of complication than those treated as an outpatient, independent of age (6.9% vs 93.0%; OR, 3.49; 95% CI, 2.0.18-6.05). No association between weight and complications was found on logistic regression (area under the curve = 0.5268; P = .66). Conclusions and Relevance Healthy children younger than 3 years may be at an increased risk for complication following tonsillectomy. Those children may also be at increased risk for complications within the first 24 hours after surgery compared with children 3 years or older. Our data suggest that complications are independent of weight in these patients. In our cohort, those patients selected for overnight observation were associated with an increased number of adverse events following tonsillectomy, suggesting that clinician judgment is crucial in determining which patients are safe for outpatient tonsillectomy.
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Affiliation(s)
- Claire M Lawlor
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - John M Carter
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana.,Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana.,University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, Louisiana
| | - Kimsey H Rodriguez
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana.,Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana.,University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, Louisiana
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Li H, Xu Y, Tong Y, Dan Y, Zhou T, He J, Liu S, Zhu Y. Sucrose Acetate Isobutyrate as an In situ Forming Implant for Sustained Release of Local Anesthetics. Curr Drug Deliv 2019; 16:331-340. [PMID: 30451111 DOI: 10.2174/1567201816666181119112952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In this study, an injectable Sucrose Acetate Isobutyrate (SAIB) drug delivery system (SADS) was designed and fabricated for the sustained release of Ropivacaine (RP) to prolong the duration of local anesthesia. METHODS By mixing SAIB, RP, and N-methyl-2-pyrrolidone, the SADS was prepared in a sol state with low viscosity before injection. After subcutaneous injection, the pre-gel solution underwent gelation in situ to form a drug-released depot. RESULT The in vitro release profiles and in vivo pharmacokinetic analysis indicated that RP-SADS had suitable controlled release properties. Particularly, the RP-SADS significantly reduced the initial burst release after subcutaneous injection in rats. CONCLUSION In a pharmacodynamic analysis of rats, the duration of nerve blockade was prolonged by over 3-fold for the RP-SADS formulation compared to RP solution. Additionally, RP-SADS showed good biocompatibility in vitro and in vivo. Thus, the SADS-based depot technology is a safe drug delivery strategy for the sustained release of local anesthetics with long-term analgesia effects.
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Affiliation(s)
- Hanmei Li
- College of Pharmacy and Biological Engineering, Chengdu University, Chengdu 610106, China
| | - Yuling Xu
- College of Pharmacy and Biological Engineering, Chengdu University, Chengdu 610106, China
| | - Yuna Tong
- Department of Nephrology, The Third People's Hospital of Chengdu, Chengdu, 610031, China
| | - Yin Dan
- College of Pharmacy and Biological Engineering, Chengdu University, Chengdu 610106, China
| | - Tingting Zhou
- College of Pharmacy and Biological Engineering, Chengdu University, Chengdu 610106, China
| | - Jiameng He
- College of Pharmacy and Biological Engineering, Chengdu University, Chengdu 610106, China
| | - Shan Liu
- Department of Laboratory Medicine, Affiliated Hospital of University of Electronic Science and Technology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu 610072, China
| | - Yuxuan Zhu
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
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Bartier S, Gharzouli I, Kiblut N, Bendimered H, Cloutier L, Salvan D. Tonsillectomy in children and in adults: changes in practice following the opening of a day-surgery unit with dedicated operating room. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:301-305. [DOI: 10.1016/j.anorl.2018.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nationwide readmissions after tonsillectomy among pediatric patients - United States. Int J Pediatr Otorhinolaryngol 2018; 107:10-13. [PMID: 29501287 DOI: 10.1016/j.ijporl.2018.01.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES 1) Investigate incidence and predictors of readmissions after tonsillectomy with or without adenoidectomy (T&A) in children. 2) Identify factors that may predict readmission. SETTINGS Nationwide cross-sectional survey of US hospital admissions. SUBJECTS and Methods: The 2013 Nationwide Readmission Database (NRD) was used to examine all-cause readmissions within 30 days of T&A in children (age <18 years). Logistic regression was used to analyze the associations of demographics, diagnosis, insurance status, length of index stay, and median household income with readmission. RESULTS 9079 children undergoing T&A resulted in 327 (3.6%) patients requiring readmission. The average age of children readmitted were 5.0 years and they were 51% female. The most common readmission diagnoses were dehydration (47%), hemorrhage (26%), and pain (16%). The average time to readmission was 7.3 days. The average times to readmission for hemorrhage, pain and dehydration were 6.3, 4.5 and 4.1 days, respectively. Children who needed respiratory intubation (OR = 4.0), had a medical or surgical complication (OR = 3.3), or prolonged hospital stay (OR = 1.03) during the index admission were more likely to be readmitted. Age, gender, payer and socioeconomic status and diagnosis of obstructive sleep apnea (OSA) did not increase the odds of readmission. CONCLUSIONS Readmissions in children after T&A were primarily due to dehydration, hemorrhage, and pain. Adequate symptom control in children has the greatest potential to reduce readmission rates following T&A.
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Schymik FA, Lavoie Smith EM, Voepel-Lewis T. Parental Analgesic Knowledge and Decision Making for Children With and Without Obstructive Sleep Apnea After Tonsillectomy and Adenoidectomy. Pain Manag Nurs 2015; 16:881-9. [DOI: 10.1016/j.pmn.2015.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/03/2015] [Indexed: 02/06/2023]
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Williams G, Bell G, Buys J, Moriarty T, Patel A, Sunderland R, Shepherd L, Brooks P, Polhill S. The prevalence of pain at home and its consequences in children following two types of short stay surgery: a multicenter observational cohort study. Paediatr Anaesth 2015; 25:1254-63. [PMID: 26406603 DOI: 10.1111/pan.12749] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The potential for pain at home in children following day case surgery has long been recognized. Pain has also been associated with behavioral disturbances and sleep disruption in children following surgery and may also impact negatively on recovery, parental and patient satisfaction, family life, healthcare use, and have an economic cost. AIM To investigate the prevalence of pain at home, and its consequences, in children following two types of short stay surgery across eight pediatric centers in the UK in an observational cohort study. Reporting of the study was done in adherence with STROBE guidelines. METHOD Two hundred and forty-one children undergoing either Tonsillectomy with or without Adenoidectomy (T's ± A's) or Orchidopexy surgery (either by Open or Laparoscopic) were recruited. Data collection was via three structured telephone interviews [Day (D) 2, 7 and 14] conducted from a clinical research facility. The normal clinical practices of the centers involved in the study were not altered in any way. Outcomes studied were (i) Pain incidence and severity; (ii) Associated consequences-incidence of psychological disturbances, unplanned use of healthcare services, and social/economic cost to families; and (iii) Comparative pain and associated outcomes for two types of surgery (T's ± A's vs Orchidopexy). RESULTS The incidence of pain following both operative models was high though it differed between the two groups. In the T's ± A's group, the incidence of pain was high throughout the study period (D2 90.1%, D3-7 88.1%, D8-14 61.8%). The Orchidopexy group demonstrated a similar pattern, though with decreased rates (D2 70.4%, D3-7 34.7%, D8-14 17.1%). Both groups showed similar patterns for the rates of behavioral disturbances (T's & A's: D2 76%, D3-7 73%, D8-14 30% and Orchidopexy: D2 37%, D3-7 20%, D8-14 10%). Seventy percent of the families reported unplanned healthcare use with pain the primary reason in 79% of these. CONCLUSIONS The prevalence of pain at home, and its potential associated consequences, is high following short stay surgery in children in the UK. In both groups, high incidences were seen for longer periods than is commonly perceived. These findings were consistent between the centers involved suggesting that this is a significant national healthcare issue with potential short- and long-term consequences for the child, their family, and health services.
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Affiliation(s)
- Glyn Williams
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Graham Bell
- Department of Anaesthesia, Royal Hospital for Sick Children, Glasgow, UK
| | - Justin Buys
- Surgical Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tony Moriarty
- Department of Anaesthesia, Birmingham Children's Hospital, Birmingham, UK
| | - Anil Patel
- Department of Anaesthesia, Royal National Throat Nose & Ear Hospital, University College Hospital, London, UK
| | - Robin Sunderland
- Department of Anaesthesia, St Georges Healthcare NHS Trust, London, UK
| | - Liz Shepherd
- Department of Anaesthesia, Sheffield Children's Hospital, Sheffield, UK
| | - Peter Brooks
- Department of Anaesthesia, Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Sara Polhill
- Department of Anaesthesia, University College Hospital London, London, UK
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Moncel JB, Nardi N, Wodey E, Pouvreau A, Ecoffey C. Evaluation of the pediatric post anesthesia discharge scoring system in an ambulatory surgery unit. Paediatr Anaesth 2015; 25:636-41. [PMID: 25581378 DOI: 10.1111/pan.12612] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To optimize the care pathway for children scheduled for ambulatory surgery, a pediatric postanesthetic discharge scoring system (Ped-PADSS) was developed from a score used in adults. The objective of this study was to evaluate this score prospectively on a cohort of children who had a day case surgical procedure. MATERIALS AND METHODS This was a single center prospective observational study. Inclusion criteria were predefined as follows: children aged 6 months-16 years at the time of the study, with a scheduled day surgery. Discharge was validated by Ped-PADSS scores ≥9, obtained at one hour intervals, after the return from the operating room and with the agreement of the surgeon. The duration of postoperative hospitalization was compared with data collected before the implementation of the score using the Student's t-test. RESULTS From February to July 2012, 1060 children were included. One hour after the return from the operating room, 97.2% of children were dischargeable using Ped-PADSS. Two hours after the return from the operating room, 99.8% of children were dischargeable. The median postoperative hospital stay (n = 1041) was reduced by 69 min compared to the median stay before using the output score (n = 150) (P < 0.01). CONCLUSION The Ped-PADSS score allows for the majority of children to be discharged 1 h after their return from the postanesthesia care unit. Children who were discharged using the Ped-PADSS score returned home in safe and optimal conditions.
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Affiliation(s)
- Jean Benoit Moncel
- Service d'Anesthésie Réanimation Chirurgicale 2, CHU Hôpital Sud, Rennes, France
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Improving postoperative tonsillectomy pain management in children--a double blinded randomised control trial of a patient analgesia information sheet. Int J Pediatr Otorhinolaryngol 2015; 79:732-9. [PMID: 25796293 DOI: 10.1016/j.ijporl.2015.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate paediatric post-tonsillectomy pain management using oxycodone when a specific analgesia information sheet is included with standard postoperative information. METHODS Oxycodone information sheets were randomly allocated to half the study children's post-tonsillectomy information pack. The trial was double-blinded to the surgeon, anaesthetist, nursing and administrative staff. Parents and children completed the pain assessment on day 3, 5 and 7. On day 10 the parents completed a questionnaire. RESULTS A postoperative analgesia information sheet provides for higher satisfaction and knowledge for parents using oxycodone (p<0.001) and children have improved postoperative pain control, most significantly at day 5 (p<0.05). Parent assessment of the child's analgesia was superior with the oxycodone information sheet, most significantly at day 3 and 7 post operatively (p<0.05). There is also a positive correlation between the parents' observed pain score and children's self reported pain score, with a low correlation efficient level observed (p<0.001). CONCLUSIONS Information sheets are useful in education and use of postoperative analgesia. The primary objective to explore the efficacy of the information sheet has proved to be successful in this setting. Given risks of opioid analgesia, it is recommended that postoperative information sheets be given to all parents, to provide for improved analgesia control and safe management of children in the postoperative period.
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