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PubMed2006

The prevention of emergence agitation with tropisetron or clonidine after sevoflurane anesthesia in small children undergoing adenoidectomy.

Postoperative agitation is a common problem after sevoflurane anesthesia in children. In the present study, we evaluated if tropisetron or clonidine could reduce the incidence of postoperative agitation after day case adenoidectomy in small children. We included 75 unpremedicated children aged 1-7 yr who were randomly assigned to receive either placebo, tropisetron (0.1 mg/kg) or clonidine (1.5 microg/kg) after anesthesia induction. Anesthesia was induced and maintained with sevoflurane. Patients also received alfentanil (20 microg/kg) and diclofenac (1 mg/kg). Postoperative pain was treated with IV oxycodone (0.05 mg/kg). Time to achieve discharge criteria was recorded. Modified pain/discomfort scale was used assess the postoperative behavior. The incidence of postoperative agitation was significantly less (32%, 8/25 patients) in the tropisetron group compared with placebo (62%, 16/26 patients), P < 0.05). Clonidine could not prevent agitation (incidence 54%, 13/24). No adverse effects were noted during the study. Discharge times were similar between the groups (between 80 and 99 min on average). In conclusion, tropisetron 0.1 mg/kg significantly reduced the incidence of postoperative agitation after sevoflurane anesthesia. Clonidine 1.5 microg/kg did not differ from placebo with respect to postoperative agitation.

Adenoidectomy↗
PubMed2002

Polysomnographic studies in children undergoing adenoidectomy and/or tonsillectomy.

Forty children (age group four to 12 years) undergoing adenoidectomy and/or tonsillectomy were subjected to pre- and post-operative polysomnography. Thorough clinical evaluation and X-ray soft tissue nasopharynx lateral view was carried out for all the patients. The tonsils were clinically graded from grade I to IV, whereas the adenoids were measured radiographically (using three different measurements) in all children. Thirty out of 40 (75 per cent) children presented with predominant obstructive symptoms, out of whom 22 (73.3 per cent) were found to have obstructive sleep apnoea (OSA), i.e. apnoea index > five per hour. The remaining 10 (25 per cent) had predominantly inflammatory symptoms on presentation and out of these two (20 per cent) were found to have OSA. Relative adenoid size expressed as a ratio between the distance from the point of maximum thickness of adenoids along a line drawn along a straight part of the basiocciput and distance from the posterior nasal spine to the antero-inferior edge of the sphenobasioccipital synchondrosis, was found to have a highly significant correlation with the grade of OSA. In our study, all patients with this ratio greater than 0.64 were found to have OSA. No correlation between tonsil size and grade of OSA was found. There was a highly significant improvement in polysomnographic scores following surgery in all patients.

Adenoidectomy↗
PubMed1977

Status of tonsillectomy and adenoidectomy: 1977.

Tonsillectomy and adenoidectomy, performed either in combination or separately, still constitute the most common major operations performed in the United States. This report is an attempt to present briefly the current status of knowledge concerning the epidemiology and natural history of conditions for which these operations are performed, the incidence of the operations, and the type and qualifications of the physicians performing the procedures, a review of the problems of the previous studies designed to determine efficacy, an update of the current study being conducted in Pittsburgh, and, finally, what little is known of the morbidity, mortality, and costs of these procedures.

Adenoidectomy↗
PubMed1990

Tonsillectomy and adenoidectomy: an inpatient or outpatient procedure?

Concern over the rising cost of health care has created a trend toward outpatient surgery. Because adenotonsillectomy is such a frequently performed procedure, there is pressure on many otolaryngologists to do this operation on an ambulatory basis. A prospective study was undertaken to evaluate the incidence and severity of postoperative hemorrhage, protracted emesis, and fever at specified times within the first 24 hours after surgery. Over a 1-year period, 1000 tonsillectomy and/or adenoidectomy patients were studied. There was a 2.1% incidence of serious complications within the first 6 postoperative hours. The incidence of serious hemorrhage, fever, and protracted emesis was 0.7% each. The incidence of significant complications between the 6th and 24th postoperative hours was 1.7%. Hemorrhage occurred in 0.4% of the patients, fever in 0.7%, and protracted emesis in 0.6%. The total incidence of hemorrhage during this time period was 1.1%. There were no deaths. The greatest percentage of complications occurred within the first 6 postoperative hours. Based on this study, outpatient tonsil and adenoid surgery should be followed by at least 6 hours of postoperative observation before discharge. The choice to perform ambulatory tonsil and adenoid surgery depends on the professional judgment of the operating physician based on this and other recent studies, the sophistication of the physician's ambulatory surgery center, and the medical and social background of the patient.

Adenoidectomy↗
PubMed1995

Perioperative ketorolac tromethamine and postoperative hemorrhage in cases of tonsillectomy and adenoidectomy.

The charts of 258 patients undergoing tonsillectomy with or without adenoidectomy between June 1991 and June 1993 were reviewed. One hundred sixty-nine of these patients received ketorolac tromethamine during the perioperative period as a nonnarcotic alternative for postoperative pain management. The incidence of postoperative hemorrhage among patients who received ketorolac tromethamine was 10.1%, compared to 2.2% in those patients who received narcotic analgesia only. The average time to adequate oral intake and discharge was evaluated. Ketorolac appeared to moderately decrease the time to adequate oral intake. The use of ketorolac did not significantly alter the time to discharge. The increased incidence of postoperative hemorrhage in patients receiving ketorolac should be considered before this medication is used in the perioperative period. The risk/benefit ratio of ketorolac use as a postoperative analgesic may be better demonstrated in a prospective study.

Adenoidectomy↗
PubMed2006

Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children.

OBJECTIVE: Tonsillectomy and adenoidectomy (T&A) is the primary therapeutic approach for sleep-disordered breathing (SDB) in children. However, residual mild SDB will be found in more than one third of these patients after T&A. We hypothesized that combined therapy with the leukotriene receptor antagonist montelukast and intranasal budesonide would result in normalization of residual SDB after T&A. METHODS: During the period of October 2002 to February 2005, children who underwent T&A for SDB underwent a routine postoperative (second) overnight polysomnographic evaluation (PSG) 10 to 14 weeks after T&A surgery. In children with residual apnea hypopnea index (AHI) >1 and <5/hour of total sleep time (TST), treatment with montelukast and intranasal budesonide aqueous solution was administered for a period of 12 weeks (M/B group), at which time a third PSG was performed. Children who had residual SDB and did not receive M/B therapy from their treating physicians were recruited as control subjects. RESULTS: Twenty-two children received M/B, and 14 children served as control subjects. Mean age, gender distribution, ethnicity, and BMI were similar in the 2 treatment groups. The mean AHI at the second PSG was 3.9 +/- 1.2/hour of TST and 3.6 +/- 1.4/hour of TST in M/B-treated and control patients, respectively. Similar nadir arterial oxygen saturation (87.3 +/- 1.2%) and respiratory arousal index (4.6 +/- 0.7/hour of TST) were recorded for both groups. However, the M/B group demonstrated significant improvements in AHI (0.3 +/- 0.3/hour of TST), in nadir arterial oxygen saturation (92.5 +/- 3.0%), and in respiratory arousal index (0.8 +/- 0.7/hour of TST) on the third PSG, whereas no significant changes occurred over time in control subjects. CONCLUSIONS: Combined anti-inflammatory therapy that consists of oral montelukast and intranasal budesonide effectively improves and/or normalizes respiratory and sleep disturbances in children with residual SDB after T&A.

Acetates↗
PubMed1994

Aerodynamic, acoustic, and perceptual changes following adenoidectomy.

Fourteen children were seen prior to adenoidectomy and at 1 month, 3 months, and 6 months following surgery. On each visit, nasal airway resistance values, nasal cross-sectional area estimates, nasalance scores, and perceptual ratings of nasality were collected. These data were analyzed to identify changes that were related to the time of the test, and to the primary indication for surgery (nasal airway obstruction or recurrent infection). Results revealed significant reduction in nasal airway resistance and significant changes in nasalance following surgery. Perceptual changes were not significant. Clinical implications of these findings are discussed.

Adenoidectomy↗
PubMedDate not supplied

[Tonsillectomies and adenoidectomies over a 60-year period (1939-1998) at the Otorhinolaryngology Department in Subotica].

INTRODUCTION: This paper presents available epidemiological data on number and types of surgeries of Waldeyer's ring over a sixty-year period, as well as their interactions. RESULTS: Out of 80.477 patients operated on in the period from December 1, 1939 to Dec 31, 1998, statistical survey included 56.564 patients (Table 1). 26.808 (46.57%) patients were operated in local anesthesia, 23.833 (41.40%) under ether narcosis, and 6.923 (12.026%) patients were operated on under general endotracheal anesthesia. 38.846 (67.48%) tonsillectomies, 12.864 (22.34%) tonsilloadenoidectomies and 5.854 (10.16%) adenoidectomies were performed. DISCUSSION: The percentage of these surgeries is very high, but in the past ten years it has fallen below 50%. General endotracheal anesthesia is being used at the Department since 1966, and ether anesthesia is not being used since 1991. We believe that the number of tonsillectomies is high, because it also includes surgeries performed under local anesthesia, in patients over ten years of age. However, we can conclude that anesthesiological procedures effectively followed trends of medical science.

Adenoidectomy↗
PubMed2004

Endoscopic electrosurgical adenoidectomy: technique and outcomes.

Recent literature has embraced the use of electrosurgery and endoscopy in adenoidectomy, with several published articles on the subject. The combination of these methods and the routine use of endoscopy have not been reported. This approach provides a direct-targeted route to the nasopharynx, improved visualization, and magnification and offers a bloodless surgical field. It allows improved evaluation of the adenoids with their peritubal extensions, their lateral and central portions, and their extension to the posterior nasal choanae and even in the posterior nasal fossae and evaluation of the posterior of the middle and inferior turbinates. It permits objective documentation of the cause of nasal obstruction with possible use in outcome assessment. It is also an effective teaching method and a motivating approach for the nursing team. Our approach has proved cost and time efficient in our minimally invasive surgical (endoscopic) operating room set-up. This article reflects the experience in a series of 96 consecutive patients performed during a 9-month period and discusses the surgical technique and patients' outcomes. The endoscope and suction cautery were systematically used for all adenoid surgery. Outcomes were evaluated using a telephone survey with a global rating questionnaire.

Adenoidectomy↗
PubMed1979

The effect of adenoidectomy on secretory otitis media in children.

139 patients, 80 boys and 59 girls aged 1 1/4--13 1/2 years suffering from serous otitis media based on otoscopy and tympanometry had adenoidectomy performed and no other surgical measures taken. The efficiency of the treatment was assessed 2--4 months later. Intially flat tympanometry curves were found in 155 ears, negative middle ear pressure in 70 ears and low curves in 20 ears. 78% of all ears and 73% of the ears with flat curves were seen to normalize during the observation periods.

Acoustic Impedance Tests↗
PubMed1992

[Nasal airflow resistance before and after adenoidectomy].

Nasal airflow resistance was measured in order to study physiological changes in the upper airway before and after adenoidectomy. The posterior method was better for measuring the state of the posterior portion of the nasal cavity, as compared with the anterior method. The posterior method was modified by improving the pressure piece, the size of which had been inadequate for insertion into a child's mouth. A positive correlation was found between the adenoidal-nasopharyngeal ratio examined on X-ray film and the nasal airflow resistance both before and after surgery. Also there was a positive correlation between the weight of the resected adenoids and nasal airflow resistance preoperatively. Nasal airflow resistance was found to be significantly higher in patients who snored, breathed by mouth or had nocturnal breathing disorders than in those without these symptoms.

Adenoidectomy↗
PubMed1999

Laser-assisted myringotomy combined with adenoidectomy in children: preliminary results.

Adenoidectomy and CO2 laser-assisted myringotomy were performed on 26 children (52 ears) diagnosed with adenoid hypertrophy and chronic otitis media with effusion. The age ranged between 2-15. The CO2 laser and a micromanipulator were adapted on the operating microscope. Repeated pulses of focused laser beam were fired in a roselike fashion in order to create a 2-mm round perforation in the antero-inferior quadrant of the eardrum. Three months after surgery, the tympanic membrane was perfectly healed. There were two cases of recurrence of middle ear fluid. There was no adverse effect and hearing results were good. We discuss the significance of these preliminary results and emphasize the need for further research.

Adenoidectomy↗
PubMed1992

Nasal mucociliary clearance and resolution of otitis media with effusion in children following adenoidectomy.

Numerous workers have studied the relationship between nasal mucociliary clearance and adenoid removal in terms of nasal function. This study was performed to investigate the role of preoperative saccharin clearance time and velocity determination in selecting children with established otitis media with effusion (OME) for adenoidectomy. Testing was not found to be particularly reproducible and there was no statistically significant relationship between mucociliary parameters and the otoscopic resolution of effusion.

Adenoidectomy↗
PubMedDate not supplied

DNA-based subtypes and antimicrobial susceptibility profiles of Haemophilus influenzae and Haemophilus parainfluenzae isolated from different tonsillar sites of children undergoing tonsillectomy and/or adenoidectomy.

We did a comparative analysis between DNA-based subtypes and antimicrobial susceptibility profiles on Haemophilus influenzae and Haemophilus parainfluenzae, isolated from multiple tonsillar sites per individual from patients with chronic recurrent tonsillitis and/or tonsillar idiopathic hypertrophy and undergoing tonsillectomy and/or adenoidectomy. A total of eighty-eight Haemophilus isolates were obtained aseptically from the surface and core of tonsils and/or adenoids of 32 out of 60 patients and identified at the species level by the X and V factors and the API NH Kit. The H. influenzae and H. parainfluenzae isolates as well as ATCC strains were tested for antimicrobial susceptibility using a panel of antimicrobial agents. Random amplified polymorphic DNA (RAPD) was done on extracted DNA from all Haemophilus isolates and ATCC strains, using one 10 mer and one 18 mer primers to subtype the two species. Antimicrobial susceptibility testing data have shown a variation in generated susceptibility patterns to tested antimicrobial agents among H. influenzae and H. parainfluenzae isolates. This variation was demonstrated too among isolates obtained from different tonsillar sites (core and surface) in a single patient. RAPD analysis identified 58/88 (66%) different RAPD patterns. Variations in RAPD patterns among H. influenzae and H. parainfluenzae were also observed in isolates obtained from different tonsillar sites of the same individual. A correlation between RAPD patterns and antimicrobial susceptibility data, have shown: 1) the predominance of one strain (RAPD pattern) of either Haemophilus species among isolated organisms per patient, and exhibiting different antimicrobial susceptibility profiles or 2) the existence of multiple strains (RAPD patterns) of either Haemophilis species per patient, and showing either a single or multiple antimicrobial susceptibility profile(s). These observations question the validity of swab cultures obtained from a single tonsillar site per patient, for detection, identification and determination of antimicrobial profiles of the etiology of tonsillitis, since swab specimens taken from only one site may or may not reflect the etiology of infection.

Adenoidectomy↗
PubMedDate not supplied

Oral fluid intake in children following tonsillectomy and adenoidectomy.

In response to concerns raised by nursing staff about forcing children to drink following tonsillectomy and adenoidectomy (T & A), a study was conducted to test for adequacy of hydration. Seventy-four children admitted to The Hospital for Sick Children in Toronto, for T & A surgery were randomly assigned to two groups: the first forced to drink after surgery according to the hospital's nursing care plan, the second given control over fluid intake. A significant difference in fluid adequacy was found between the groups 6 hours after return from the recovery room but none at 8 hours. As a result, fluid management of children after T & A surgery has been changed so that they are encouraged rather than forced to drink.

Adenoidectomy↗
PubMed2005

An alternative to a postnasal pack for the arrest of perioperative hemorrhage following curettage adenoidectomy.

Controlling bleeding with standard postnasal packing following curettage adenoidectomy is only occasionally warranted. Children find the packing experience unpleasant, and removal of the packing usually requires general anesthesia. We describe a simple technique for packing the nasopharynx with bilateral nasal tampons via an anterior approach. The tampons are much easier to insert than standard packing, they are well tolerated while in place, and they can be easily removed with perhaps only some light sedation rather than general anesthesia.

Adenoidectomy↗