S245 – Pulmonary Complications after Coblation Tonsillectomy

Objectives 1) Evaluate an institutional experience with postoperative pulmonary complications using the Coblator (ArthroCare Corp, Sunnyvale, CA), for pediatric tonsillectomy. 2) Understand how to minimize and prevent pulmonary complications following coblation tonsillectomy. Methods Case series of 4 tonsillectomy patients who developed clinical signs of aspiration following surgery, from October 2006 to January 2008. Results 4 pediatric patients were reported in this case series. All 4 experienced perioperative fever, tachycardia, pulmonary desaturation, and cough following tonsillectomy using the Coblator. In 1 case, the patient had course respirations, a chest x-ray demonstrating diffuse pulmonary infiltrates, and was unable to maintain his oxygen saturations without supplemental oxygenation. In all cases, the symptoms, to include fever, resolved by post-operative day 2. No long-term sequelae were noted. In all cases, the patients were intubated using an uncuffed endotracheal tube. Conclusions Pulmonary aspiration is a possible adverse consequence of oropharyngeal pooling of saline while performing a tonsillectomy using the Coblator. Pediatric patients in whom an uncuffed endotracheal is used are more likely to aspirate the irrigation. Recognition of this potential complication allows the surgeon to take the necessary precautions to avoid this complication by using a throat pack, trendelenberg positioning, and avoidance of pooling of irrigation in the oropharynx.

Download Full-text

An Evaluation of Preoperative Methods of Preventing Postoperative Pulmonary Complications

Anaesthesia and Intensive Care ◽

10.1177/0310057x7700500109 ◽

1977 ◽

Vol 5 (1) ◽

pp. 56-59 ◽

Cited By ~ 6

Author(s):

I. C. Wheatley ◽

K. J. Hardy ◽

C. E. Barter

Keyword(s):

Vital Capacity ◽

Forced Expiratory Volume ◽

Pulmonary Complications ◽

Respiratory Care ◽

Postoperative Pulmonary Complications ◽

X Ray ◽

Function Test ◽

Postoperative Respiratory Complications ◽

Chest X Ray ◽

Intensive Physiotherapy

The effectiveness of three current regimes of preoperative respiratory care in reducing postoperative respiratory complications following herniorrhaphy was studied prospectively. No smoking for five days plus intensive physiotherapy, five days no smoking, and routine hospital admission two days preoperatively were the regimes. Clinical, bacteriological, chest X-ray, blood gas and respiratory function test data were the criteria for assessment. The same surgical and anaesthetic team performed each operation. No statistical difference between the groups for pulmonary complications was noted. A significant correlation was found between the preoperative vital capacity and arterial pO2; also between the preoperative forced expiratory volume in one second-vital capacity ratio with the postoperative arterial pO2.

Download Full-text

Lung ultrasound compared with chest X-ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study

Anaesthesia ◽

10.1111/anae.14243 ◽

2018 ◽

Vol 73 (8) ◽

pp. 946-954 ◽

Cited By ~ 25

Author(s):

H. R. Touw ◽

K. L. Parlevliet ◽

M. Beerepoot ◽

P. Schober ◽

A. Vonk ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Lung Ultrasound ◽

Pulmonary Complications ◽

Cardiothoracic Surgery ◽

Postoperative Pulmonary Complications ◽

X Ray ◽

Chest X Ray

Download Full-text

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.6.peds18716 ◽

2019 ◽

Vol 24 (5) ◽

pp. 549-557

Author(s):

Malia McAvoy ◽

Heather J. McCrea ◽

Vamsidhar Chavakula ◽

Hoon Choi ◽

Wenya Linda Bi ◽

...

Keyword(s):

Conservative Management ◽

Functional Outcomes ◽

Pediatric Patients ◽

Clinical Presentation ◽

Case Series ◽

Csf Leak ◽

Single Institution ◽

The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

Download Full-text

Laryngeal stent for acute and chronic respiratory distress in seven dogs with laryngeal paralysis

Open Veterinary Journal ◽

10.4314/ovj.v10i1.2 ◽

2020 ◽

Vol 10 (1) ◽

pp. 4-10 ◽

Cited By ~ 1

Author(s):

María Cecilia Ricart ◽

Sergio Martín Rodríguez ◽

Roberto Miguel Duré

Keyword(s):

Respiratory Distress ◽

Alternative Therapy ◽

Clinical Signs ◽

Surgical Techniques ◽

Case Series ◽

Laryngeal Function ◽

Laryngeal Stenosis ◽

Laryngeal Paralysis ◽

Silicone Stent

Background: Laryngeal paralysis, failure of arytenoid cartilage, and vocal fold abduction are commonly seen in older medium to large breed dogs. Observation of laryngeal function in dogs and cats is performed by transoral visualization. There are a variety of surgical techniques; aspiration pneumonia is the most common complication associated with surgical correction of laryngeal paralysis. The aim of this case series is to report on the placement of a laryngeal silicone stent in seven dogs with laryngeal paralysis and its use as an alternative treatment of respiratory distress caused by laryngeal paralysis and/or its use for laryngeal stenosis as complication of laryngeal paralysis surgery.Case description: Seven dogs presented with either episode of gagging, mild-to-severe inspiratory distress, or cyanosis because of a laryngeal paralysis or laryngeal stenosis. In each case, the laryngeal paralysis was diagnosed by direct laryngoscopy. They were treated with a silicone laryngeal stent (Stening®) that substantially improved the clinical signs. Each dog had a different outcome because of other pathologies; however, the laryngeal pathology was successfully treated with the stent.Conclusion: The placement of the laryngeal stent is an easy technique to learn and practice, it could avoid the lifethreatening complications of the laryngeal paralysis at the acute phase, and it could be a noninvasive and long-term alternative therapy for laryngeal paralysis in dogs. The results in these clinical cases are encouraging for considering the laryngeal stent as a therapeutic alternative. Key words: Canine, Polyneuropathy, Prosthesis, Surgery.

Download Full-text

Long-Term Changes in Vertebral Morphology After Cervical Spinal Fusion in Adolescent Pediatric Patients: Retrospective Case Series with up to a Minimum 12 Years of Follow-up

World Neurosurgery ◽

10.1016/j.wneu.2018.10.136 ◽

2019 ◽

Vol 122 ◽

pp. e765-e772

Author(s):

Yuichiro Abe ◽

Katsuhisa Yamada ◽

Kuniyoshi Abumi ◽

Norimasa Iwasaki ◽

Hideki Sudo

Keyword(s):

Spinal Fusion ◽

Pediatric Patients ◽

Case Series ◽

Retrospective Case ◽

Retrospective Case Series ◽

Long Term Changes

Download Full-text

Value of Preoperative Chest X-ray Examinations in Children

PEDIATRICS ◽

10.1542/peds.60.5.669 ◽

1977 ◽

Vol 60 (5) ◽

pp. 669-672

Author(s):

Shashikant M. Sane ◽

Robert A. Worsing ◽

Cornelius W. Wiens ◽

Rajiv K. Sharma

Keyword(s):

Prospective Study ◽

Pediatric Patients ◽

Anesthetic Technique ◽

Chest Film ◽

X Ray ◽

Patients Âgés ◽

Chest X Ray ◽

A Prospective Study ◽

Preoperative Chest

To assess the value of routine preoperative chest x-ray films in pediatric patients, a prospective study of 1,500 patients, ages newborn to 19 years, was undertaken. Of all the patients, 7.5% demonstrated at least one roentgenographic abnormality, with 4.7% of the patients demonstrating a totally unsuspected significant roentgenographic anomaly. In 3.8% of the patients, surgery was either postponed or cancelled or the anesthetic technique was altered as a result of the roentgenographic finding. It is believed that the routine preoperative chest film is justified if the film is evaluated before surgery and the results clinically followed up.

Download Full-text

Anterior diaphragmatic hernias in children: long-term surgical outcomes

Voprosy praktičeskoj pediatrii ◽

10.20953/1817-7646-2021-3-7-15 ◽

2021 ◽

Vol 16 (3) ◽

pp. 7-15

Author(s):

D.A. Morozov ◽

◽

D.V. Khaspekov ◽

E.A. Okulov ◽

V.G. Masevkin ◽

...

Keyword(s):

Surgical Treatment ◽

Diaphragmatic Hernia ◽

Complex Analysis ◽

Long Term Results ◽

Long Term Outcomes ◽

X Ray ◽

Hernial Sac ◽

Chest X Ray ◽

Diaphragmatic Hernias

Anterior diaphragmatic hernia (ADH) is a rare congenital pathology that occurs in children with a frequency of 1:4800 (1–6% of all congenital diaphragmatic hernias). There are many controversial aspects in the surgical treatment of patients with ADH: the choice of surgical approach, the method of diaphragmatic repair and the feasibility of excision of the hernial sac. Objective. To conduct a comparative analysis of the surgical treatment of patients with ADH in different clinics, assessing longterm outcomes. Patients and methods. The medical records of 7 children with ADH who underwent surgical repair in different clinics (in time period from 2009 to 2019) were retrospecively reviewed. Evaluating the long-term results of ADH repair was made by telephone and online surveys of the parents of patients and by outpatient examination of children (chest x-ray in two projections). Results. In a ten-year period, 7 patients (4 boys and 3 girls) were operated on with a diagnosis of “anterior diaphragmatic hernia” at the age of 3 months to 12 years. In most children, a hernia was discovered accidentally by chest x-ray. Laparoscopic correction was performed in 5 (71%) cases, thoracoscopic correction – in 2 cases (29%). The main difference in surgical tactics in ADH patients was the manipulation with the hernial sac – the hernial sac was excised in 4 (57%) patients, but it was left in three cases (43%). The defect closure was performed by “full-thickness” separated sutures that fix the diaphragm to the anterior abdominal wall during laparoscopy (5) and to the chest tissue during thoracoscopy (2); in some cases, additional fixation to the rib (4) was performed. Sutures were tied extracorporeally and buried in the subcutaneous layer in 6 (86%) patients. Average follow-up was 7 years. While evaluating long-term outcomes no ADH recurrence were found. Conclusions. There are still many controversial aspects in the surgical treatment of ADH patients. In our opinion, multicenter studies with complex analysis of long-term results are required to standardize the surgical treatment of such patients. Key words: anterior diaphragmatic hernia, Larrey hernia, long-term outcomes, Morgani hernia

Download Full-text

Suggests More Tests for Chest Pain Diagnosis

PEDIATRICS ◽

10.1542/peds.61.1.143b ◽

1978 ◽

Vol 61 (1) ◽

pp. 143-144

Author(s):

Michael F. Elmore ◽

Glen A. Lehman

Keyword(s):

Chest Pain ◽

Physical Examination ◽

Pediatric Patients ◽

Laboratory Studies ◽

Psychiatric Interview ◽

X Ray ◽

Pain Diagnosis ◽

Chest X Ray ◽

Pain Characteristics ◽

Diagnostic Work

Driscoll et al. (Pediatrics 57:648, May 1976) reported a series of 43 patients with chest pain evaluated by history and physical examination, psychiatric interview, screening laboratory studies, ECG, and chest x-ray film. No organic cause was identified in 45% of patients, and various psychiatric aspects of the pain were discussed. The history obtained from pediatric patients is often suboptimal, and specific pain characteristics and associations cannot be defined. We therefore propose that more vigorous diagnostic work-ups are necessary before chest pain can be classed as "idiopathic."

Download Full-text

Clinical characteristics and long-term outcome of lung lobe torsions in cats: a review of 10 cases (2000–2021)

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x211054816 ◽

2021 ◽

pp. 1098612X2110548

Author(s):

Catherine Tindale ◽

Filippo Cinti ◽

Matteo Cantatore ◽

Alistair Freeman ◽

Leonardo Cavaliere ◽

...

Keyword(s):

Intraoperative Complications ◽

Clinical Signs ◽

Case Series ◽

The Other ◽

Complication Rates ◽

Term Outcome ◽

Long Term Outcome ◽

Lung Lobe ◽

Lung Lobes

Case series summary Lung lobe torsion is rare in cats. The aim of this multi-institution retrospective study was to describe clinical and diagnostic findings, treatments and outcomes of lung lobe torsion (LLT) in 10 cats. Dyspnoea and tachypnoea were the most common clinical signs. Pleural effusion was present in nine cats at presentation. Fluid analysis confirmed chylothorax in three cats. Nine cats underwent CT and five cats had thoracic radiographs taken. A diagnosis was made preoperatively in six cats, while in the other four cats it was made at exploratory thoracotomy. Affected lung lobes were the right cranial (n = 4/11), left cranial (n = 4/11) and right middle (n = 3/11). One cat had a concurrent torsion of two lung lobes. Lung lobectomy was successfully performed in all cases. Based on clinical, diagnostic and lung histopathology findings, three cats had idiopathic and seven cats secondary LLT. Intraoperative complications included hypotension and hypothermia in four and five cats, respectively. Postoperative complications occurred in six cats and lead to euthanasia or death in four cats, whereas complications resolved in the other two cats. Three cats were euthanased within 5 weeks of discharge. For the three cats surviving long term, including one euthanased at 252 days postoperatively, owner-described outcomes and quality of life were considered good to excellent. Relevance and novel information Secondary LLT associated with underlying thoracic pathology was associated with high complication rates and poor outcomes. Long-term outcomes of cats undergoing surgery for LLT and surviving the perioperative period were deemed good to excellent.

Download Full-text