The Case for an Outpatient “Approach” for All Pediatric Tonsillectomies and/or Adenoidectomies: A 4-Year Review of 1419 Cases at a Community Hospital

2002 ◽  
Vol 127 (1) ◽  
pp. 101-108 ◽  
Author(s):  
Duncan S. Postma ◽  
Fain Folsom
Keyword(s):  
Retrospective Study ◽  
Study Design ◽  
Pediatric Patients ◽  
Community Hospital ◽  
Perioperative Complications ◽  
Single Group ◽  
Older Children ◽  
Safety And Efficacy ◽  
Outpatient Procedures ◽  
Outpatient Center

OBJECTIVE: We sought to document the safety and efficacy of approaching all pediatric tonsillectomies and/or adenoidectomies (T/A) as outpatient procedures. STUDY DESIGN AND SETTING: We conducted a 4-year retrospective study of 1419 pediatric patients undergoing T/A at an outpatient center with procedures performed by a single group of surgeons. RESULTS: None of the 593 patients undergoing an adenoidectomy and only 5 (0.6%) of those having a tonsillectomy had significant bleeding postoperatively. There were no readmissions for airway problems. Children younger than age 3 were most likely to have complications and to be held for overnight observations. CONCLUSIONS: Most children can be safely discharged after T/A. The higher incidence of perioperative complications in children who are younger than 3 years of age paralleled their higher rate of overnight observation. SIGNIFICANCE: Children less than 3 years of age require more careful observation, especially after tonsillectomy and more likely will need to be observed overnight than older children.

Does Hydrogen Peroxide Mouthwash Improve the Outcome of Secondary Post-Tonsillectomy Bleed? A 10-year Review

2005 ◽  
Vol 133 (2) ◽  
pp. 202-205 ◽  
Author(s):  
Irumee Pai ◽  
Stephen Lo ◽  
Satsuki Brown ◽  
Abbad G. Toma
Keyword(s):  
Hydrogen Peroxide ◽  
Retrospective Study ◽  
Study Design ◽  
Broad Spectrum ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Control Group ◽  
Intravenous Antibiotics ◽  
The Common

Objective: To determine whether hydrogen peroxide (H2O2) mouthwash influences the outcome of secondary post-tonsillectomy hemorrhage in children. Study Design: Ten-year retrospective study of all children with secondary post-tonsillectomy hemorrhage. Setting: Tertiary otolaryngology center. Results: Of the 156 patients, 59 received H2O2 and 97 did not. All patients received broad-spectrum intravenous antibiotics. The average rehospitalization duration due to hemorrhage was 1.7 days (H2O2 group) and 1.6 days (control group). In the H2O2 group, 8.5% required surgery, compared with 10.3% in the control group. Further hemorrhage episodes requiring readmission occurred in 3.4% of the H2O2 group and 3.1% of controls. There was no difference between the 2 groups in rehospitalization duration ( P = 0.49), rate of surgical intervention ( P = 0.85), and rate of readmission with further hemorrhage ( P = 0.92). Conclusion: Hydrogen peroxide mouthwash does not improve the outcome of secondary post-tonsillectomy hemorrhage in pediatric patients. Significance: This study does not support the common practice of treating post-tonsillectomy hemorrhage with H2O2.

scholarly journals Management of Incarcerated Indirect Hernia in Pediatric Patients with Intra-abdominal Hypertension: A Retrospective Study

2021 ◽  
Author(s):  
Wenyan Qi ◽  
Baoling Chen ◽  
Bin Lei ◽  
Min Zhan
Keyword(s):  
Retrospective Study ◽  
Mortality Rate ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Perioperative Complications ◽  
Abdominal Pressure ◽  
Indirect Inguinal Hernia ◽  
Decompressive Laparotomy ◽  
Abdominal Hypertension ◽  
Surgical Methods

Abstract Background: Intra-abdominal hypertension (IAH) is a critical condition that can be induced by incarcerated indirect inguinal hernia (IIIH). There are currently no specific guidelines for laparotomy in children. To determine whether laparotomy should be performed during the management in pediatric patients with IIIH combined with IAH.Methods: This is a retrospective study of pediatric patients with IIIH and IAH who were admitted and treated at the Department of General Surgery of Jiangxi Provincial Children’s Hospital from 01/2010 to 06/2020. The patients were divided into Group A (intra-abdominal pressure (IAP) of 10-20 mmHg) and Group B (IAP ≥ 21 mmHg). Each group was further subdivided into Group 1 (decompression) and Group 2 (no decompression) depending on whether decompressive laparotomy was performed or not. The last follow-up was three months after discharge.Results: A total of 49 patients were enrolled, and divided into group A1 (n = 21), A2 (n = 10), B1 (n = 4), B2 (n = 14). Compared with patients in group A1, those who had decompression (group A2) has longer hospital stay (7.5 ± 1.9 vs. 5.2 ± 2.1, p = 0.01), higher 24h-postoperative IAP (11.3 ± 2.4 vs 9.5 ± 2.1, p = 0.03), longer PICU stay (2.1 ± 0.9 vs. 1.1 ± 0.5, p = 0.001), and more perioperative complications. In contrast, among patients with IAP higher than 20mmHg, those who had decompresion via laparotomy (group B2) had comparable hospital stay (7.1 ± 5.1 vs. 8.5 ± 4.1, p = 0.57), a shorter PICU stay (3.0 ± 1.4 vs. 4.7 ± 1.3, p = 0.04) and lower mortality rate (7.1% vs. 50%, p = 0.04) than patients in group B1.Conclusions: The selection of appropriate surgical methods according to IAP and based on clinical diagnosis can relieve the pain of children, shorten hospital stay, and reduce the mortality rate.

Use of a preoperative bleeding questionnaire in pediatric patients who undergo adenotonsillectomy

2008 ◽  
Vol 139 (4) ◽  
pp. 546-550 ◽  
Author(s):  
Greg R. Licameli ◽  
Dwight T. Jones ◽  
Jodi Santosuosso ◽  
Catherine Lapp ◽  
Carlo Brugnara ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Study Design ◽  
Potential Risk ◽  
Pediatric Patients ◽  
Postoperative Bleeding ◽  
Bleeding Disorders ◽  
Risk Of Bleeding

Objective To determine the efficacy of a preoperative bleeding questionnaire (POBQ) and coagulation screening in predicting hemorrhage associated with adenotonsillectomy. Study Design Retrospective study. Subjects and Methods Between January 1998 and December 2003, 7730 tonsillectomy and adenotonsillectomy patients were administered the POBQ preoperatively. Further coagulation screening was based on POBQ responses. Results A total of 232 (3.0%) of 7730 had postoperative bleeding; 184 (3.2%) of 5782 patients who had negative questionnaires bled postoperatively compared with 48 (2.5%) of 1948 patients with positive questionnaires ( P = 0.126). Of 1948 patients with positive questionnaires, 141 (7.2%) had abnormal preoperative coagulation screens and 9 (6.4%) of 141 bled; of the 1807 (92.8%) with negative coagulation screens, 39 (2.2%) bled ( P = 0.005). Conclusion The POBQ is an effective tool for identifying patients who are at potential risk for post-tonsillectomy bleeding. Patients with both a positive POBQ and coagulation screen had a statistically higher likelihood of postoperative bleeding than other patients. The POBQ allowed the identification of individuals with bleeding disorders to be treated before surgery, likely decreasing the risk of bleeding in these patients.

Post-Discharge Events Occurring after Dental Treatment under Deep Sedation in Pediatric Patients

2017 ◽  
Vol 41 (3) ◽  
pp. 232-235 ◽  
Author(s):  
Esti Davidovich ◽  
Liron Meltzer ◽  
Jacob Efrat ◽  
David Gozal ◽  
Diana Ram
Keyword(s):  
Adverse Events ◽  
Study Design ◽  
Pediatric Patients ◽  
Dental Treatment ◽  
Deep Sedation ◽  
Parent Report ◽  
Older Children ◽  
Post Discharge ◽  
Convenience Sample ◽  
Sedative Agent

Purpose: Deep sedation is often required in dentistry for treating children with uncooperative behavior. We assessed immediate post-sedation events during the first 24 hours after dental treatment under deep sedation in children, and examined correlations to a number of variables. Study design: Information was collected from medical files for a convenience sample of children between the ages of 1 and 16, who were treated under deep sedation at one clinic (propofol alone or combined with a sedative agent). Parents were interviewed by telephone regarding the first 24 hours following treatment. Results: Among 32 children under age 6 years, 26 (81.3%) had at least one post sedation complication, compared to 19/22 (86.4%) aged 6 and older, p>0.05. According to parent report, 13 (59.1%) of the older children had pain, compared to 6 (18.8%) of the younger ones, p=0.002. For no patient in the younger group compared to 18.2% in the older group was dizziness reported as a complication, p=0.023. Among those who received a sedative agent, 93.3% had one or more complications; 26.7% had nausea or vomiting. The respective rates were 79.5% and 5.1% among those treated only with propofol. Conclusions: Though safe, deep sedation poses complications and adverse events.

scholarly journals Parasitic infections in Swiss children: Are we overtesting?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Corinne Légeret ◽  
Céline Rüttimann ◽  
Hans Fankhauser ◽  
Henrik Köhler
Keyword(s):  
Retrospective Study ◽  
Positive Result ◽  
Pediatric Patients ◽  
Intestinal Parasites ◽  
Gastrointestinal Symptoms ◽  
International Travel ◽  
Parasitic Infections ◽  
Stool Samples ◽  
Stool Specimens

Abstract Background A wide variation of causes can lead to gastrointestinal symptoms in children- an infection with parasites is one of them. The expansion of international travel might lead to an increase in testing children for a correspondent infection. Currently there are no guidelines available, which patients should be tested for a possible parasitical infection. The aim of the study was to characterize Swiss children suffering from intestinal parasites, in order to provide more knowledge for the clinician who should be tested. Methods This is a retrospective study of Swiss pediatric patients, whose stools have been tested for parasites and helminths. Results A total of 1855 stool samples, belonging to 572 different children with an average age of 7.9 years, were tested within a 10-year period. The prevalence of a positive result was 4.2%, of which all were positive for Blastocystis, and 12.5% had a co-infection with Endolimax nana. Conclusion Immigrants, immune compromised children with diarrhea and pediatric patients with bloody or protracted diarrhea should have 2 different stool specimens examined for a possible parasitical infection.

scholarly journals Endoscopic retrograde cholangiopancreatography in infants and children

2021 ◽  
Vol 09 (03) ◽  
pp. E292-E296
Author(s):  
Tone Lise Åvitsland ◽  
Lars Aabakken
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Medical Records ◽  
Pediatric Patients ◽  
Biliary Stricture ◽  
Infants And Children ◽  
University Hospital ◽  
Older Children ◽  
Endoscopic Retrograde ◽  
Procedure Codes ◽  
In Infants And Children

Abstract Background and study aims Previous reports have suggested that endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients are safe. However, the total number of cases presented in the literature remains small. We present results regarding safety and outcomes in pediatric patients undergoing ERCP at Oslo University Hospital. Patients and methods Patients < 18 years who underwent ERCP between April 1999 and November 2017 were identified using procedure codes. Medical records were examined for age, gender, diagnosis, indications, type of sedation, findings, interventions, and complications. Results A total of 244 procedures were performed in 158 patients. Fifty-six of these were in 53 infants (age ≤ 1 year). Mean age was 8.8 years. The youngest patient was 8 days old. Mean weight was 5.0 kg in infants, the smallest weighing 2.9 kg. Cannulation failed in 19 (7.8 %). The main indication in infants was suspicion of biliary atresia (n = 38). Six of the procedures (10.7 %) were therapeutic. In children the main indications were biliary stricture (n = 64) and investigation of primary sclerosing cholangitis (PSC) (n = 45). 119 (63.2 %) of these procedures were therapeutic.Complications were uncommon in infants; only two episodes of infection were registered. In children (> 1 year) post-ERCP pancreatitis were seen in 10.4 %. Conclusions Our retrospective series of ERCP procedures includes 56 procedures in infants, which is one of the largest series presented. Complications in infants are rare and post-ERCP pancreatitis was not seen. In older children 10.4 % experienced post-ERCP pancreatitis. In expert hands, ERCP was shown to be acceptably feasible and safe in infants and children.

scholarly journals All-case Japanese post-marketing surveillance of the real-world safety and efficacy of rituximab treatment in patients with refractory nephrotic syndrome

2021 ◽  
Author(s):  
Mana Kobayashi ◽  
Yutaro Kageyama ◽  
Takashi Ando ◽  
Junko Sakamoto ◽  
Shohji Kimura
Keyword(s):  
Nephrotic Syndrome ◽  
Standard Deviation ◽  
Real World ◽  
Pediatric Patients ◽  
Safety And Efficacy ◽  
The Real ◽  
Post Marketing Surveillance ◽  
Post Marketing ◽  
Refractory Nephrotic Syndrome ◽  
Observation Period

Abstract Background Rituximab is conditionally approved in Japan for use in patients with refractory nephrotic syndrome. To meet the conditions of approval, an all-case post-marketing surveillance study was conducted to confirm the real-world safety and efficacy of rituximab in patients of all ages with refractory nephrotic syndrome. Methods All patients scheduled to receive rituximab treatment for refractory nephrotic syndrome were eligible to register (registration: August 29, 2014 through April 15, 2016); the planned observation period was 2 years from the initiation of rituximab treatment (intravenous infusion, 375 mg/m2 once weekly for four doses). The study was conducted at 227 hospitals throughout Japan. Adverse drug reactions (ADRs) were collected for safety outcomes. The efficacy outcomes were relapse-free period and the degree of growth in pediatric (< 15 years) patients. Results In total, 997 (447 pediatric) patients were registered; 981 (445) were included in the safety analysis set; 852 (402) completed the 2-year observation period; and 810 (429) were included in the efficacy analysis set. Refractory nephrotic syndrome had developed in childhood for 85.0% of patients, and 54.6% were aged ≥15 years. ADRs were observed in 527 (53.7%) patients, treatment-related infection/infestation in 235 (24.0%) patients, and infusion reactions in 313 (31.9%) patients. The relapse-free period was 580 days (95% confidence interval, 511–664). There was a significant change in height standard deviation score (pediatric patients; mean change, 0.093; standard deviation, 0.637; P = 0.009). Conclusion The safety and efficacy of rituximab treatment in patients with refractory nephrotic syndrome were confirmed in the real-world setting. Clinical trial registration UMIN000014997.

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