Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Tonsillectomy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 433 records · Page 24Linked to original sources
PubMed2003

Ropivacaine compared to lidocaine for tonsillectomy under local anaesthesia.

The aim of the present study was to investigate the safety and efficacy of ropivacaine compared to lidocaine for tonsillectomy under local anaesthesia. During the last 2 years, 77 patients undergoing tonsillectomy under local anaesthesia in the seated position were randomised to receive ropivacaine or lidocaine. The following parameters were recorded: time to surgical anaesthesia, the duration of the procedure, postoperative pain, the need for analgesics during the first 10 h after surgery, cardiac arrhythmias, the occurrence of allergic reaction and larynx spasm. It took significantly longer to reach surgical anaesthesia in the ropivacaine patients (8.3+/-1.3 min versus 2.7+/-0.8 min.), but the pain immediately following the procedure was significantly lower (1.0+/-0.4 versus 2.6+/-1.0). Adjuvant analgetics were administered later and in significantly lower doses in the ropivacaine patients. There were no adverse reactions. In conclusion, ropivacaine in local tonsillectomy is safe, has a longer onset-time, but is more efficient concerning postoperative pain than lidocaine.

Adolescent↗
PubMed1987

Efficacy of tonsillectomy and adenoidectomy as an outpatient procedure: a preliminary report.

One of the recent trends in medical practice has been the use of ambulatory surgery for a substantial number of surgical procedures. A prospective evaluation of tonsillectomy and tonsillectomy with adenoidectomy as outpatient procedures at the Children's Hospital Medical Center in Cincinnati, OH, is reported. Patients who were felt to be inappropriate candidates for adenotonsillectomies as outpatients included patients under 3 years of age, patients who lived more than one hour from the hospital and patients who demonstrated obstructive sleep apnea or who had other significant medical problems. A review of this 9-month experience indicates that outpatient surgery for adenotonsillectomy is both safe and cost-effective in most circumstances. In an analysis of complications requiring readmission to the hospital (bleeding, dehydration, poor social situation), patients who had their original surgery performed on an ambulatory basis had no more complications than patients who were hospitalized following their surgery. Excluding the professional fees for the surgeon and anesthesiologist, a savings of approximately 50% can be expected from the performance of a tonsillectomy and adenoidectomy on an outpatient basis.

Adenoidectomy↗
PubMed1992

Body growth in relation to tonsillar enlargement and tonsillectomy.

Severe airway obstruction caused by tonsillar enlargement can result in disturbances in body growth. The effect of this interference and of tonsillectomy in the child with only moderate symptoms have been less satisfactoril evaluated. In this study, 122 children with symptoms and signs of tonsillar obstruction were investigated concerning the height and weight before and after tonsillectomy. None of the individuals demonstrated cardiopulmonary complications of tonsillar obstruction. Altogether 10% of the children exhibited abnormalities in body weight and/or length prior to surgery. Especially during the first postoperative year, the weight and height gain exceeded the expected in 75% of the patients. The accelerated weight gain increased with tonsil size, but there was no relation to the extent of difficulties in swallowing or sleeping disruptions. The results support the hypothesis that tonsillar hypertrophy frequently is associated with disturbances in body growth and that this is seldom demonstrable prior to tonsillectomy.

Adolescent↗
PubMed1994

Iatrogenic hyponatremia: a cause of death following pediatric tonsillectomy.

Death following pediatric tonsillectomy is very rare. If deaths occur, they are most commonly due to bleeding or aspiration. In this presentation, we would like to illustrate another potentially lethal complication following the pediatric tonsillectomy, iatrogenic hyponatremia. We have encountered 3 patients who have developed post-operative hyponatremia. This has resulted in 2 deaths. The third patient was successfully treated and developed no permanent sequela. We will discuss the etiology and pathophysiology of post-operative hyponatremia including guidelines for administering fluid and electrolytes intra-operatively and post-operatively. We expect that fatal post-operative hyponatremia can be avoided in the pediatric tonsillectomy patients.

Child↗
PubMed1996

'Hemostatic pause' in pediatric tonsillectomy?

A randomized prospective study was performed on 101 children undergoing dissection tonsillectomy in two different sequences. In the 'pause' sequence, a period of inactivity lasting 1.5 min ('hemostatic pause') with the Boyle-Davis gag relaxed and the fossae packed with gauze swabs was implemented after the tonsils were excised. Hemorrhage was controlled exclusively by ligatures. The duration of tonsillectomy and the number of ligatures used were accurately recorded. The procedure was identical in the 'no pause' group but the pause period was omitted. No reactionary haemorrhage occurred. There was no significant difference in the operating time between the two groups, but the mean number of ligatures required was significantly reduced in the 'pause' sequence. We conclude that 'hemostatic pause' in tonsillectomy reduces the amount of ligatures needed for satisfactory hemostasis.

Child↗
PubMed2007

Homeopathic Arnica montana for post-tonsillectomy analgesia: a randomised placebo control trial.

OBJECTIVE: To evaluate the efficacy of Homeopathic Arnica in reducing the morbidity following tonsillectomy. METHODS: Randomised double blind, placebo controlled trial at a tertiary referral centre. 190 patients over the age of 18 undergoing tonsillectomy were randomised into intervention and control groups receiving either Arnica 30c or identical placebo, 2 tablets 6 times in the first post-operative day and then 2 tablets twice a day for the next 7 days. The primary outcome measure was the change in pain scores (visual analogue scale) recorded by the patient on a questionnaire over 14 days post-operatively; Secondary outcome measures were: analgesia consumption, visits to the GP or hospital, antibiotic usage, the day on which their swallowing returned to normal and the day on which they returned to work. RESULTS: 111 (58.4%) completed questionnaires were available for analysis. The Arnica group had a significantly larger drop in pain score from day 1 to day 14 (28.3) compared to the placebo group (23.8) with p < 0.05. The two groups did not differ significantly on analgesic consumption or any of the other secondary outcome measures (number of post-operative visits to GP, use of antibiotics and secondary haemorrhage readmissions). CONCLUSION: The results of this trial suggest that Arnica montana given after tonsillectomy provides a small, but statistically significant, decrease in pain scores compared to placebo.

Adult↗
PubMed2004

The effect of fusafungine on post-operative pain and wound healing after pediatric tonsillectomy.

OBJECTIVE: To investigate the effect of fusafungine spray on pain and healing process after pediatric tonsillectomy. METHODS: Sixty children with ages between 4 and 14 years underwent tonsillectomy or adenotonsillectomy. The patients were randomly divided into three groups and each group consisted of 20 patients. Group 1 was treated with antibiotic (amoxicillin-clavulanic acid) plus analgesic (acetaminophen), group 2 was treated with fusafungine plus analgesic (acetaminophen) and group 3 was treated with only fusafungine. The average ages were 7.8 + 3.4, 6.6 + 2.9, and 8.2 + 3.7 for groups 1, 2, and 3, respectively. Clinical evaluations were made after the operation on the 1st (T1), 3rd (T3), 7th (T7), 10th (T10), and 14th days (T14). RESULTS: There was no significant difference in post-operative pain between study groups on the post-operative 1st, 3rd, and 7th days (P > 0.05), a statistically significant difference was present between groups 1 and 3, and groups 1 and 2 on the post-operative 10th and 14th day (P = 0.018 and 0.037, respectively). Pain was less in groups 2 and 3 than in group 1 on the 10th and 14th day. Also there was a significant difference in healing time of the tonsillary beds between groups 1 and 2, and groups 1 and 3 on the 10th and 14th post-operative day (P = 0.031 and 0.001, respectively). Healing was better in groups 2 and 3 than in group 1 on the 10th and 14th day. CONCLUSION: Fusafungine administration after tonsillectomy was found to be beneficial on post-operative pain and wound healing of tonsillary beds in pediatric population.

Acetaminophen↗
PubMed2005

Modified infiltration technique in tonsillectomy: expanded case report of 25 children.

OBJECTIVE: To introduce a modified infiltration technique of anesthetic mixture in order to reduce post-tonsillectomy pain based on histo-anatomic observations and tonsil's innervation detection. DESIGN: Histo-anatomic, expanded case report. SETTING: Tertiary care facility in Beirut, Lebanon. PATIENTS: One hundred and seven patients who underwent tonsillectomy allocated in three groups. INTERVENTIONS: Histo-anatomic observations were studied in 62 patients (group I). Nerve-stimulator detection was performed in group II (20 children). An expanded case report of 25 children (group III) was conducted using a modified infiltration technique based on the findings of the histo-anatomic observations and nerve detection. OUTCOME MEASURES: Post-operative pain at 0, 6, 12h and once daily for the 10-day follow-up period, hemodynamic stability, hospital stay, patient satisfaction and analgesics consumption were assessed. RESULTS: The nerve-stimulator confirmed the histo-anatomic findings by strong contractions of the superior constrictor muscle, soft palate and uvula when the needle is mainly in the middle part of the peritonsillar area where the glossopharyngeal nerve branches predominate. No visual analogue scale median exceeded 1 for any child at any predetermined time interval, only three children (12%) required opoiods during the follow-up period. All children (100%) were discharged the same day, only 4% of parents were unsatisfied. Hemodynamic stability was maintained during pre- and post-operation. CONCLUSION: This modified technique with minimal volume of anesthetic mixture seems to reduce post-operative pain in tonsillectomy patients; a randomized double-blinded prospective study was designed based on the findings in this initial series of children.

Adolescent↗
PubMed2005

Does topical lidocaine with adrenaline have an effect on morbidity in pediatric tonsillectomy?

OBJECTIVE: To evaluate the efficacy of lidocaine with adrenaline on post-operative morbidity in pediatric patients after tonsillectomy. STUDY DESIGN: A double blind prospective randomized controlled clinical study. METHODS: The study is consisting of two groups of pediatric patients following tonsillectomy performed in a university hospital. One group received lidocaine with adrenaline soaked swabs packed in their tonsillar fossae while the control group received saline-soaked swabs. Chi-square and two-tailed unpaired Student's t-tests were used to compare the two independent groups. p<0.05 was accepted as statistically significant. RESULTS: No significant pain-relieving effect was seen in the lidocaine with adrenaline group (p>0.05) and also the other post-operative parameters such as nausea, fever, vomiting, odor, bleeding, otalgia and trismus were not statistically different between the two groups based on chi-square analysis (p>0.05). There were no complications associated with lidocaine and adrenaline. CONCLUSION: We suggest that application of topical lidocaine with adrenaline seems to be a safe and easy medication for local anesthetic use. However, in our study, lidocaine with adrenaline offered no advantage over placebo in the control of post-operative pain and other morbidity related factors following pediatric tonsillectomy. We therefore do not recommend topical application of lidocaine with adrenaline for reducing morbidity in pediatric tonsil surgery.

Adolescent↗
PubMed2006

Ropivacaine compared to bupivacaine for post-tonsillectomy pain relief in children: a randomized controlled study.

OBJECTIVE: To compare the effects of ropivacaine and bupivacaine on post-tonsillectomy pain in children. METHODS: Forty-six children aged 2-12 years, undergoing tonsillectomy were enrolled in the study. Group 1 (n=16) received bupivacaine, group 2 (n=15) received ropivacaine, and a group 3 (control) (n=15) received 9% NaCl (saline) infiltrated around each tonsil. Pain was evaluated using a modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) recorded 15 min and 1, 4, 12, 16, and 24h postoperatively. RESULTS: No difference was found in the demographic data among the groups. The pain scores were similar between the bupivacaine and ropivacaine groups (p>0.05). The pain scores in both analgesia groups were significantly (p<0.05) lower 1, 4, 12, 16, and 24h postoperatively compared to the control group. Analgesic requirements and the time to first analgesia were also significantly (p<0.05) different between the analgesia and control groups. CONCLUSION: Local ropivacaine infiltration is a safe and effective method and equivalent to bupivacaine for post-tonsillectomy pain.

Amides↗
PubMed2006

Can postoperative pains following tonsillectomy be relieved by honey? A prospective, randomized, placebo controlled preliminary study.

OBJECTIVE: To compare the effectiveness of acetaminophen versus acetaminophen-plus-honey following pediatric tonsillectomy and adenoidectomy. DESIGN: Prospective, randomized, and placebo controlled clinical trial. SETTING: Tertiary care facility in Ankara, Turkey. PATIENTS: Sixty consecutive tonsillectomy patients randomized to two groups. INTERVENTIONS: The acetaminophen group was treated with antibiotics (amoxicillin-clavulonic acid), acetaminophen and placebo, acetaminophen-plus-honey group was treated with antibiotics (amoxicillin-clavulonic acid), acetaminophen, and honey. Visual analogue scale (VAS) was applied for subjective assessment of postoperative pains, while the number of painkillers taken daily and awakening at night due to pain were used for objective assessment. The amount of epithelization was used for assessment of tonsillary fossa recovery. OUTCOME MEASURES: The difference between acetaminophen and acetaminophen-plus-honey groups was statistically significant both in terms of VAS and number of painkillers taken within the first 2 postoperative days (p<0.001). Although there was no statistically significant difference between groups regarding the VAS scores on the 3rd postoperative day and after, the number of painkillers taken differed significantly until the 8th postoperative day (p<0.001 for first 7 postoperative days; p=0.003 for 8th day). No significant difference was found between groups regarding the number of awakening at night (p=0.36). Tonsillary fossa epithelization was more rapid in the acetaminophen-plus-honey group (p<0.001). CONCLUSION: Oral administration of honey following pediatric tonsillectomy may relieve postoperative pain and may decrease the need for analgesics. Prospective, randomized, and double-blind studies should further be conducted in order to confirm the data obtained in this study and develop a standard protocol to achieve maximum clinical efficiency.

Acetaminophen↗
PubMed2006

Pulse-oximetery is useful in determining the indications for adeno-tonsillectomy in pediatric sleep-disordered breathing.

OBJECTIVE: Although first line therapy of sleep-disordered breathing (SDB) in children is adeno-tonsillectomy, the indications for this operation have not yet been clearly established. We investigated whether pulse-oximetry is useful for determining the optional treatment modality for pediatric SDB. METHOD: Two hundred and thirty-two children presenting with snoring and gasping had their oxygen saturation levels examined during sleep. Among them, 86 underwent on adeno-tonsillectomy and were evaluated pre- and post-surgery. We also examined 25 healthy children as controls. RESULTS: Little desaturation was observed in healthy children. The difference in oxygen saturation levels of the patients between pre- and post-surgery was closely correlated with the pre-surgery levels. We examined the reaction operation characteristics and concluded that children with an oxygen desaturation index of 4% or more (ODI4) of more than 1.5 and/or ODI3 of more than 3.5 should undergo surgery. CONCLUSION: Pulse-oximetry is useful in determining the indications for adeno-tonsillectomy.

Adenoidectomy↗
PubMed2004

Pediatric total tonsillectomy using coblation compared to conventional electrosurgery: a prospective, controlled single-blind study.

OBJECTIVE: Postoperative recovery after tonsillectomy using Coblation excision (CES) was compared with conventional electrosurgery (ES). STUDY DESIGN AND SETTING: Patients aged 3 to 12 years from 3 clinical sites were randomly assigned and blinded to receive tonsillectomy using CES (n = 44) or ES (n = 45). RESULTS: Operative parameters did not differ between groups. Return to normal diet, activity, and pain-free status were similar, although fewer CES patients contacted the physician regarding postoperative complications (33% vs 54%; p = 0.081), experienced nausea (35% vs 62%, p = 0.013), or had localized site-specific swelling (p < 0.05) during the 2 weeks after surgery. In addition, CES children tended to discontinue prescription narcotics 1 day earlier than ES patients (7 vs 8 days, p = 0.071) and took one half as many daily doses. More CES than ES parents rated the postoperative experience as 'better than expected' (79% vs 60%, p = 0.055). CONCLUSION AND SIGNIFICANCE: Children who received CES tonsillectomy appeared to experience a better quality postoperative course, with no detriment to operative benefits of conventional electrosurgery.

Child↗
PubMed2004

Safety of outpatient tonsillectomy in children: a review of 6 years in a tertiary hospital experience.

OBJECTIVE: We present our experience with outpatient tonsillectomy in children and critically review safety to support the outpatient policy. STUDY DESIGN AND SETTING: We conducted a retrospective chart review from January 1995 through December 2000 in the pediatric otolaryngology unit of a tertiary care university hospital. RESULTS: One thousand two hundred forty-three patients were accepted in the outpatient program with permissive criteria. Postoperative observation time ranged from 3 to 5 hours (median, 4.5 hours). The overall rate of complications was 9.3% (n = 116). Primary and secondary bleeding rates were 6.27% (n = 78) and 0.48% (n = 6), respectively. Thirty-six children (2.9%) had major bleeding; 2 of them were not identified in day-hospital (0.16%). Discharge was delayed in 103 patients (8.3%), and 13 patients showed complications after discharge (about 1% readmission rate). CONCLUSION: Our program outcomes support safety. Outpatient surgery is meant to provide comfort to the patient and efficiency to the health care system, without impairing safety; in our experience, most tonsillectomies in children comply with these objectives. SIGNIFICANCE: Outpatient tonsillectomy in children may be safe even with permissive criteria, when an appropriate setting is available.

Ambulatory Surgical Procedures↗
PubMed2004

A randomized clinical trial of the effectiveness of a scheduled oral analgesic dosing regimen for the management of postoperative pain in children following tonsillectomy.

The purpose of this study was to determine whether around-the-clock (i.e. ATC) dosing of acetaminophen with codeine, with or without nurse coaching, compared to standard care with as needed (i.e. PRN) dosing: reduced children's reports of pain intensity with and without swallowing; increased pain relief, and increased analgesic consumption. Eighty children, 6-15 years, undergoing tonsillectomy were randomized to one of three treatment groups to receive acetaminophen with codeine (120 mg/12 mg/5 ml) for 3 days after surgery: PRN group (N = 28)-every 4 h PRN, with standard postoperative instructions, without nurse coaching; ATC group (N = 26)-every 4 h ATC, with standard postoperative instructions, without nurse coaching; and ATC+coaching group (N = 26)-every 4 h ATC, with standard postoperative instructions and nurse coaching. In all three groups, significant decreases were found over time in pain intensity scores at rest (P < 0.001) and with swallowing (P < 0.001). However, mean pain scores at rest and with swallowing were >3/10 until the fourth evening after tonsillectomy. Children in both ATC dosing groups received significantly greater amounts of acetaminophen and codeine than children in the PRN group (P < 0.003). No significant differences were found in the amount of analgesic administered between the ATC dosing groups with and without nurse coaching. No significant differences were found in the amount of nausea and vomiting among the three groups. Scheduled dosing of acetaminophen with codeine did not provide adequate pain relief for children following tonsillectomy. Nurse coaching does not increase parent's adherence with an ATC dosing schedule.

Acetaminophen↗
PubMed2006

Patterns of pain and analgesic use in 3- to 7-year-old children after tonsillectomy.

Tonsillectomy is a common surgical procedure usually associated with moderate to severe pain. Although self-report is the gold standard for pain assessment, researchers have not studied young children at home with self-report measures. The purpose of this study was to describe the patterns of self-reported pain intensity and analgesic administration in 3- to 7-year-old children undergoing tonsillectomy during the operative day in the hospital and the first 2 postoperative days at home in Iceland. As part of a larger study, 68 children undergoing tonsillectomy were taught to use the Wong-Baker FACES Pain Rating Scale. Pain intensity scores and data about administration of analgesics were collected from children, the medical record, and the parents over a 3-day period. Children received primarily acetaminophen or acetaminophen with codeine in the hospital. At home, 99% of doses administered were acetaminophen only. Most doses were administered rectally. Forty percent of children received 24-hour therapeutic doses in the hospital. Only 10% received a 24-hour therapeutic dose at home despite significant pain scores of 4 or 5 persisting through the second postoperative day. Younger children were less likely to receive acetaminophen with codeine. In the hospital, children with pain intensity scores of 4 or 5 received prescribed morphine only 13% of the time. Children experienced clinically significant pain through the second postoperative day and will probably require a change in protocol to provide more aggressive pain management earlier. This study extends to younger children the research evidence that current pain protocols are inadequate.

Adult↗
PubMedDate not supplied

["Usual" morbidity of pediatric tonsillectomy: a study of 126 cases].

Pediatric tonsillectomy is a common procedure in the ENT practice, usually in a Day-surgery basis. The aim of the present work is to further investigate postoperative morbidity to improve both treatment and quality of assistance. 126 children operated in our Day-surgery unit were included in the study, and a questionnaire with items related to postoperative pain, otalgia, halitosis, vomitig, fever and other aspects was filled by their parents or relatives in charge. Significative pain lasting until the third or fourth day was recorded in half of the cases. At the end of the first week most of the children are improved, although only 55% are eating normally. Vomitting, usually the day of the surgery, is described by one third of cases. In our experience, ambulatory tonsillectomy is a safe procedure with low incidence of complications, which are mild. However, the delay in returning to a normal diet and the relative high incidence of vomiting bring into question the inclusion of tonsillectomy in a Day-Surgery program, making necessary to implement treatment protocols to avoid such problems.

Adolescent↗
PubMed2006

[Indications for tonsillectomy and adenoidectomy: consensus document by the Spanish Society of ORL and the Spanish Society of Pediatrics].

Tonsillectomy and adenoidectomy are probably the commonest surgeries performed in the ENT field as well as the most controversial ones. There are very few consensus documents available for these two surgeries. In 1997 a document written by the two mentioned Societies was published, in order to update such document regarding tonsillectomy and adenoidectomy procedures we have met this year representatives from both scientific societies and a new document has been elaborated. We describe the diagnostic criteria of pharyngo-tonsillitis and adenoiditis as well as of obstructive sleep apnoea syndrome, with the aim of a better comprehension of these processes when a decision needs to be made regarding surgery. Indications and contraindications of tonsillectomy and adenoidectomy are here described.

Adenoidectomy↗