Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes

Objective: To analyze safety and efficacy of single-dose ketorolac after primary palatoplasty (PP). Design: Consecutive cohort of patients undergoing PP, comparing to historical controls. Setting: A large academic children’s hospital. Patients, Participants: A consecutive cohort of 111 patients undergoing PP (study n = 47) compared to historical controls (n = 64). Interventions: All patients received intraoperative acetaminophen, dexmedetomidine, and opioids while the study group received an additional single dose of ketorolac (0.5 mg/kg) at the conclusion of PP. Main Outcome Measures: Safety of ketorolac was measured by significant bleeding complications and need for supplementary oxygen. Efficacy was assessed through bleeding, Face Legs Activity Cry Consolability (FLACC) scale, and opioid dose. Results: Length of stay was similar for both groups (control group 38.5 hours [95% CI: 3.6-43.3] versus study group 37.6 hours [95% CI: 31.3-44.0], P = .84). There were no significant differences in all postoperative FLACC scales. The mean dose of opioid rescue medication measured as morphine milligram equivalents did not differ between groups ( P = .56). Significant postoperative hemorrhage was not observed. Conclusions: This is the first prospective study to evaluate the safety and efficacy of single-dose ketorolac after PP. Although lack of standardization between study and historical control groups may have precluded observation of an analgesic benefit, analysis demonstrated a single dose of ketorolac after PP is safe. Further investigations with more patients and different postoperative regimens may clarify the role of ketorolac in improving pain after PP.

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Pediatric airway surgery: Management of laryngotracheal stenosis in infants and children

The Egyptian Journal of Otolaryngology ◽

10.1007/bf03546434 ◽

2014 ◽

Vol 30 (2) ◽

pp. 188-190

Author(s):

Philippe Monnier

Keyword(s):

Infants And Children ◽

Laryngotracheal Stenosis ◽

Pediatric Airway ◽

Airway Surgery ◽

Surgery Management ◽

In Infants And Children

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Dexmedetomidine decreased the post‐thyroidectomy bleeding by reducing cough and emergence agitation – a randomized, double‐blind, controlled study

BMC Anesthesiology ◽

10.1186/s12871-021-01325-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sang Hun Kim ◽

Yoo Seok Kim ◽

Seongcheol Kim ◽

Ki Tae Jung

Keyword(s):

Postoperative Bleeding ◽

Postoperative Hemorrhage ◽

Controlled Study ◽

Emergence Agitation ◽

Double Blind ◽

Extubation Time ◽

Registration Number ◽

Recovery From Anesthesia ◽

Postanesthetic Care Unit ◽

Group D

Abstract Background Bleeding after thyroidectomy occurs due to violent coughing during emergence. Dexmedetomidine is helpful for the smooth emergence and suppression of cough. The purpose of the present study was to compare the effects of dexmedetomidine on postoperative bleeding after thyroidectomy. Methods Randomized, double-blind, controlled trials were conducted in female patients (ASA I–II, aged 20 to 60 years). The patients were randomly allocated into two groups. Approximately 15 min before the end of the surgery, dexmedetomidine was administered (0.6 µg/kg/h) without a loading dose in group D (n = 69), and normal saline was administered in group S (n = 70) at the same infusion rate. Hemodynamic data, coughing reflex, extubation time, Ramsay sedation scale (RSS), and recovery time were assessed during the administration of the study drugs and recovery from anesthesia. The amount of postoperative hemorrhage was measured for 3 days. Results Data from a total of 139 patients were analyzed. The incidence of severe cough was significantly lower in group D than in group S (4.3 % vs. 11.5 %, P = 0.022). The emergence agitation in the postanesthetic care unit was significantly lower in group D than in group S (P = 0.01). Postoperative bleeding was significantly lower in group D than in group S until the second postoperative day (P = 0.015). Conclusions Dexmedetomidine can be helpful in decreasing bleeding after thyroidectomy by reducing coughing and emergence agitation. Trial registration This study was registered at http://clinicaltrials.gov (registration number NCT02412150, 09/04/2015).

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Preoperative Predictors and Costs of 30-Day Readmission Following Inpatient Pediatric Tonsillectomy in the United States

Otolaryngology ◽

10.1177/0194599820980709 ◽

2021 ◽

pp. 019459982098070

Author(s):

Habib Khoury ◽

Shaghauyegh S. Azar ◽

Hannah Boutros ◽

Nina L. Shapiro

Keyword(s):

Health Care ◽

Financial Burden ◽

Preoperative Assessment ◽

Health Care Expenditures ◽

The United States ◽

Postoperative Hemorrhage ◽

International Classification Of Disease ◽

Neurologic Disorders ◽

Common Causes ◽

National Trends

Objectives To understand national trends in 30-day postoperative readmission following inpatient pediatric tonsillectomy and adenoidectomy. Study Design Retrospective cohort study. Setting Nationwide Readmissions Database. Methods We used the Nationwide Readmissions Database to identify and analyze 30-day readmissions following inpatient tonsillectomy from 2010 to 2015. Using the International Classification of Disease codes, we identified 66,652 patients and analyzed the incidence, causes, risk factors, and costs of 30-day readmission. Results Of 66,652 patients who underwent inpatient tonsillectomy, 2660 (4.0%) experienced a readmission. Readmitted patients were more commonly aged <2 years (23.4 vs 10.6%, P = .01) and had a greater burden of comorbidities, including preoperative anemia (3.9 vs 1.3%, P < .001), coagulopathy (3.5 vs 1.4%, P < .001), and neurologic disorders (19.1 vs 6.6%, P < .001). Readmitted patients experienced higher rates of postoperative complications (17.4 vs 9.0%, P < .001) and had a longer length of stay (4.5 vs 2.2 days, P < .001). Index cost of hospitalization was higher among readmitted patients ($14,129 vs $7307, P < .001), and each readmission cost an additional $7576. Postoperative hemorrhage (21.3%) and dehydration (17.7%) were the 2 most common causes for readmission. Independent predictors of readmission included age <3 years, multiple comorbidities, and postoperative neurologic complications. The incidences of tonsillectomies and readmissions declined during the study period, most notably between 2010 and 2012. Conclusion Readmission after inpatient tonsillectomy and adenoidectomy places a substantial financial burden on the health care system. Targeted strategies to improve preoperative assessment and optimize postoperative care may prevent readmission, reduce unnecessary health care expenditures, and improve patient outcomes.

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A Morphometric Study of the Maxillary Artery and Lingula in Relation to Mandibular Ramus Osteotomies and TMJ Surgery

European Journal of Dentistry ◽

10.1055/s-0039-1697825 ◽

2010 ◽

Vol 04 (02) ◽

pp. 166-170 ◽

Cited By ~ 3

Author(s):

Huseyin Avni Balcioglu ◽

Cenk Kilic ◽

Altan Varol ◽

Hasan Ozan ◽

Necdet Kocabiyik ◽

...

Keyword(s):

Infratemporal Fossa ◽

Postoperative Hemorrhage ◽

Morphometric Study ◽

Maxillary Artery ◽

Mandibular Ramus ◽

Main Trunk ◽

Tmj Ankylosis ◽

Bony Landmarks ◽

Inferior Border ◽

Mandibular Notch

Objectives: Mandibular osteotomies and resection of the temporomandibular joint (TMJ) ankylosis are the mostly performed surgical procedures in the infratemporal fossa, which is in close proximity with the main trunk of the maxillary artery (MA). It is imperative to avoid the trunk or branches of the maxillary artery, otherwise, massive intraoperative or postoperative hemorrhage may develop. The goal of the study was to investigate the position of the maxillary artery in the infratemporal fossa and the lingula of the mandible.Methods: Significant landmarks were selected on the mandibles of formalin fixed cadavers, and the distances were measured between the maxillary artery and the bony landmarks with a digital caliper.Results: The average distances between the MA and the articular eminence, the medial cortex of the mandibular ramus, the inferior border of the pterygoid fovea and the mandibular notch were 1.67±0.48 mm, 5.38±2.47 mm, 16.84±1.74 mm, 2.94±0.52 mm, respectively. Course pattern of the MA at the subcondylar level was also mapped. In order to determine the position of the lingula, the average distances between the tip of the lingula and the mandibular notch, the inferior border of the ramus, the anterior margin of the ramus and posterior margin of the ramus were measured and found as 15.4±2.1 mm, 49.5±4.3 mm, 18.1±2.7 mm, 16.6±2.5 mm, respectively. No significant differences were found between the right and left sides, for all parameters.Conclusions: The studied parameters will assist and navigate clinicians to determine the anatomic proximity to the maxillary artery, and, minimize the risk of damaging the vessel. (Eur J Dent 2010;4:166-169)

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