Post-tonsillectomy pain management in pediatric patients-a review

Tonsillectomy is a common surgical procedure performed in the pediatric age group. Although tonsillectomy is a safe surgery, it is associated with significant post-operative pain. Analgesia after tonsillectomy is often inadequate. Severe post-tonsillectomy throat pain has been described for more than a decade. Parents often worry for handling the pain of their children in home. Post-tonsillectomy pain is often considered as a long lasting and intense in nature. Post-tonsillectomy pain in children is an important problem which overstrains the patient, family and hospital staff. Post-tonsillectomy pain in children is an important problem which overstrains the patient, family and hospital staff. Regulatory alteration in the analgesic armamentarium, particularly in pediatric patients are making the treatment of post-tonsillectomy pain more difficult. Post-tonsillectomy pain in pediatric patients continues to be highly debated clinical issue and also an area of active research. Post-tonsillectomy pain can result in significant morbidity among pediatric patients. There are several analgesics available; each one has its own risk profile and unique side effects when used in pediatric age group in post-tonsillectomy period. This review article provides an update on recent management of post-tonsillectomy pain in pediatric patients. This article reviews the epidemiology, pathophysiology, impact of post-tonsillectomy pain in children and details of medications used for controlling post-tonsillectomy pain.

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Current treatment of post-tonsillectomy pain: a review

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213911 ◽

2021 ◽

Vol 7 (10) ◽

pp. 1708

Author(s):

Santosh Kumar Swain

Keyword(s):

Pediatric Patients ◽

Hospital Staff ◽

Current Treatment ◽

Review Article ◽

Age Group ◽

Throat Pain ◽

Pediatric Age Group ◽

Post Operative Pain ◽

Active Research ◽

Pain Analgesics

Tonsillectomy is one of the most common surgical procedures performed by an otorhinolaryngologist. This surgery is done more in the pediatric age group. Although tonsillectomy is safe and effective surgery, it is usually associated with significant post-operative pain. Analgesics used for post-tonsillectomy pain is often inadequate. Severe throat pain following tonsillectomy has been documented for decades. Patients or parents/caretakers often worry about such severe pain in the home. The pain following tonsillectomy is usually intense and long-lasting. The severe post-tonsillectomy pain often overstrains the patient, family, and hospital staff. Regular changes in the analgesic armamentarium, particularly in pediatric patients are making the treatment of post-tonsillectomy pain more challenging. Pain following the tonsillectomy period continues to be a highly debated issue and an area of active research. Throat pain in the post-tonsillectomy period can result in significant morbidity among patients. There are different analgesics available; each one has its risk profile and side effects when used for controlling post-tonsillectomy pain. This review article discusses on recent management of post-tonsillectomy pain. This article reviews the epidemiology, pathophysiology, impact of post-tonsillectomy pain, and details of medications used for controlling post-tonsillectomy pain.

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Pediatric Isolated Sinonasal Schwannoma: A New Case Report and Literature Review

Case Reports in Medicine ◽

10.1155/2016/2786030 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Xiao-Hui Ma ◽

Hai-Chun Zhou ◽

Can Lai ◽

Kun Zhu ◽

Xuan Jia

Keyword(s):

Case Report ◽

Literature Review ◽

Nasal Cavity ◽

Maxillary Sinus ◽

Paranasal Sinuses ◽

Pediatric Patients ◽

Age Group ◽

Pediatric Age ◽

Pediatric Age Group ◽

Group A

Schwannomas of the paranasal sinus are uncommon. Less than 4% of schwannomas involve the nasal cavity and paranasal sinuses, even less in the pediatric age group. A case of schwannoma arising in maxillary sinus in a 2.5-year-old Chinese boy is reported. The basis for discussion of this case is the exceptional rarity of sinonasal schwannoma in pediatric patients.

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Partial Cricotracheal Resection with Primary Anastomosis in the Pediatric Age Group

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949710601102 ◽

1997 ◽

Vol 106 (11) ◽

pp. 891-896 ◽

Cited By ~ 50

Author(s):

Yoram Stern ◽

David L. Walner ◽

Mark E. Gerber ◽

Robin T. Cotton

Keyword(s):

Pediatric Patients ◽

Primary Anastomosis ◽

Surgical Techniques ◽

Exercise Intolerance ◽

Age Group ◽

Pediatric Age ◽

Cricotracheal Resection ◽

Pediatric Age Group ◽

Laryngotracheal Reconstruction ◽

Partial Cricotracheal Resection

The traditional approach to severe subglottic stenosis (SGS) in the pediatric age group is laryngotracheal reconstruction (LTR). This approach may be complex and multistaged, with variable and unpredictable success rates in the individual patient. Excellent results have been reported in adults who had severe SGS and underwent partial resection of the cricoid and primary thyrotracheal anastomosis. This procedure has not been widely reported in infants and children. We report our experience with this procedure in 16 pediatric patients with grade III or IV SGS. Eleven patients had multiple previous LTR operations. The preoperative evaluation, surgical techniques, postoperative care, complications, and final results are described and discussed. Fourteen patients were decannulated after the procedure, 1 patient needed a second open procedure prior to decannulation, and 1 patient with concomitant bronchopulmonary dysplasia remains cannulated, for an overall 94% decannulation rate. Fourteen patients have no limitation of respiration, and 1 patient has moderate exercise intolerance. The results of this series suggest that partial cricotracheal resection with primary anastomosis is a relatively safe and effective procedure for pediatric patients with severe SGS.

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Clinical pattern of cutaneous infestations in pediatric age group attending a tertiary care centre

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20214909 ◽

2021 ◽

Vol 8 (1) ◽

pp. 35

Author(s):

Raghavon U. U. ◽

Neela V. Bhuptani ◽

Bharti K. Patel ◽

Sagar Bhimani

Keyword(s):

Pediatric Patients ◽

Dietary Habits ◽

Skin Diseases ◽

Tertiary Care ◽

Outpatient Department ◽

Health Concern ◽

Care Hospital ◽

Age Group ◽

Pediatric Age ◽

Pediatric Age Group

Background: Skin diseases are a serious health concern for children of all ages, and they are linked to a high rate of morbidity. In comparison to adults, children's dermatological problems are more impacted by socioeconomic position, dietary habits, climatic exposure, and the external environment. The purpose of this study was to determine the prevalence of infestations among pediatric patients who visited the dermatology outpatient department in a tertiary care hospital.Methods: From December 2019 to September 2020, all newly diagnosed, untreated male and female pediatric patients (from neonates to adolescents of 14 years of age) attending dermatology outpatient department (OPD) were assessed to determine the prevalence of Infestations within the pediatric population. A thorough history was gathered, followed by a meticulous dermatological examination and if indicated, regular investigations were done and were recorded in predesigned performa.Results: The analysis included 50 patients who had been infested. There were 43 cases (86%) of scabies and 7 cases (14%) of pediculosis capitis.Conclusions: The infestations in the pediatric age group are associated with a high communicable rate so it’s important to diagnose these conditions early to contain the spread and limit the morbidity.

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Histopathological study of upper versus lower poles of tonsil in chronic tonsillitis among pediatric age group

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194942 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1646

Author(s):

Sudhakar Rao M. S. ◽

Apoorva P. ◽

Bindu Rani K. M. ◽

Shadakshari G.

Keyword(s):

Pediatric Patients ◽

Neck Surgery ◽

Chronic Tonsillitis ◽

Histopathological Study ◽

Low Grade ◽

High Grade ◽

Age Group ◽

Pediatric Age ◽

Pediatric Age Group ◽

Grade 3

Background: To compare the histopathological findings between upper and lower poles of tonsil in pediatric age group keeping in view the local and distant effects of chronic tonsillitis.Methods: Three relevant parameters, grade of inflammation (GOI), activity of inflammation and hyperplasia were histopathologically examined in the tonsils of n=60 pediatric patients with chronic tonsillitis who underwent tonsillectomy in Department of Otorhinolaryngology and Head and Neck Surgery, VIMS, Ballari, Karnataka, India. These parameters were analyzed and were subjected for statistical analysis. Results: In our study, among 60 patients, n=32 (54.2%) were female and n=28 (45.8%) were male. Those aging 5-10 years were n=34 (57.6%) and 11-15 years were n=26 (42.4%). The tonsillar enlargement of grade 3 were present in n=46 patients (77.7%), n= 12 patients (20%) had grade 2 and n=2 patients (1.3%) had grade 4.Conclusions: The GOI and hyperplasia parameters in our study have highly significant association statistically (p<0.01) in histopathology of upper poles when compared with lower poles both sides. Further, the activity of inflammation when analyzed was more in upper pole when compared with lower poles both sides, However this parameter in left side upper and lower poles of tonsil was not statistically significant . Among the 60 cases studied, in all the cases, the GOI was of high grade and activity of inflammation and hyperplasia was low grade. Chronic tonsillitis and histopathology of chronically infected tonsils becomes an important step in the management of the disease.

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Amitriptyline overdose in emergency department of university hospital

Human & Experimental Toxicology ◽

10.1177/0960327113520019 ◽

2014 ◽

Vol 33 (9) ◽

pp. 980-990 ◽

Cited By ~ 9

Author(s):

S Paksu ◽

L Duran ◽

M Altuntas ◽

H Zengin ◽

O Salis ◽

...

Keyword(s):

Pediatric Patients ◽

Clinical Laboratory ◽

Good Prognosis ◽

High Serum ◽

University Hospital ◽

Age Group ◽

Pediatric Age ◽

Pediatric Age Group ◽

Life Threatening ◽

Amitriptyline Poisoning

Objective: The purpose of this study was to evaluate the patients with acute amitriptyline poisoning and investigate predictive factors for the development of life-threatening complications. Methods: Demographics, clinical, laboratory, and electrocardiographic (ECG) findings of 250 patients were evaluated retrospectively. Predictive parameters for the development of serious complications were studied. Results: Median age of patients was 14.6 years, of which, 70% of patients were female and 66% were in pediatric age group. The most common pathological clinical finding and laboratory abnormality were alteration of consciousness and hyponatremia. The rate of convulsive seizure, arrhythmia, and respiratory depression were 17 (6.8%), 16 (6.4%), and 11 (4.4%), respectively. These complications were more seen in pediatric patients than adults (15.8% and 1.2%). The incidence of hyponatremia was more in pediatric patients and severe poisoning groups (38.8 and 53.4%, respectively). The levels of amitriptyline and nortriptyline were significantly higher in the group with complications than the group without complications ( p < 0.05). All adult patients were discharged with good prognosis. In pediatric age group, one patient was discharged with severe neurological sequelae and one patient died. QRS duration >100 ms, long corrected QT duration interval, and low Glasgow Coma Score (GCS) at admission were identified as independent risk factors for the development of life-threatening complications (odds ratio: 69.4, 1.9, and 1383, respectively; p < 0.05). Conclusion: Amitriptyline poisoning may be associated with life-threatening complications, especially in pediatric age group and in patients with hyponatremia. Low GCS, presence of hyponatremia, high serum drug levels, and pathological ECG findings on admission may be helpful in predicting the development of complications and poor prognosis.

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Long-Term Antithyroid Treatment in Pediatric and Juvenile Graves’ Disease

International Journal of Endocrinology and Metabolism ◽

10.5812/ijem.106491 ◽

2020 ◽

Vol 18 (Suppl) ◽

Cited By ~ 1

Author(s):

Hossein Delshad ◽

Miralireza Takyar

Keyword(s):

Pediatric Patients ◽

Radioactive Iodine ◽

Remission Rate ◽

Current Evidence ◽

Graves Disease ◽

Age Group ◽

Pediatric Age ◽

Pediatric Age Group ◽

Review Articles

Context: Thyroid hormones can affect the development and function of the central nervous system and various other organs. As such, the pathologic excess of these hormones, known as thyrotoxicosis, can be the source of significant damage during childhood and adolescence. The objective of this study was to review the management of Graves’ disease (GD) in the pediatric age group, especially concerning long-term antithyroid drug (ATD) treatment. Evidence Acquisition: A thorough search of literature published from 1980 to 2019 was performed in PubMed only for English language literature. The following key terms were used: “Graves’ disease, hyperthyroidism, thyrotoxicosis in children, thyrotoxicosis remission, thyrotoxicosis relapse, definite therapy, radioactive iodine, thyroidectomy, anti-thyroid drugs, propylthiouracil, methimazole, and carbimazole”. We also did a thorough search in review articles, observational studies, open-label/controlled randomized/non-randomized trials, and meta-analyses, as well as the articles cited by textbooks, chapters, and review articles, which led us to locate older sources of information on the topic. Results: More than 90% of thyrotoxicosis in the pediatric age group is attributable to GD. A host of strategies, including ATDs, radioiodine therapy, and surgery, are employed to treat this entity. However, there is still significant controversy regarding the most optimal strategy. Current evidence suggests that ATDs are the best initial treatment in pediatric patients with GD. Although ATDs are widely used, the duration of their administration is controversial and varies significantly between protocols. A major problem is the high relapse rate (up to 70%), but extending the duration of such treatment could potentially bring the remission rate up to 88%. Indications for using radioactive iodine treatment include the lack of remission following years of receiving ATDs, poor compliance, and the emergence of a major side effect. In pediatric patients aged five-years-old or younger who suffer from very large goiter, severe ophthalmopathy, and persistent hyperthyroidism, as well as those with the lack of response to or showing adverse effects of ATDs, it is advisable to consider total or near-total thyroidectomy. Conclusions: Antithyroid drugs are the mainstay of treatment of juvenile GD, and long-term methimazole therapy increases the remission rate in pediatric GD.

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A Prospective Analysis of Derangement of Coagulation Profile in Adult and Pediatric Age Group in Moderate-to-Severe Traumatic Brain Injury

Indian Journal of Neurotrauma ◽

10.1055/s-0038-1676556 ◽

2018 ◽

Vol 15 (02/03) ◽

pp. 087-093

Author(s):

Swarup Sohan Gandhi ◽

Manish Mann ◽

Shashikant Jain ◽

Ugan Singh Meena ◽

Virendra Deo Sinha

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Pediatric Patients ◽

Age Groups ◽

Age Group ◽

Pediatric Age ◽

Coagulation Profile ◽

Pediatric Age Group ◽

Severe Tbi

Abstract Background and Aim of Study Coagulopathy is a common occurrence following traumatic brain injury (TBI). Various studies have reported the incidence and risk factors of coagulopathy and their correlation with poor outcome in adult as well as pediatric age group. In our study, we aim to analyze trauma-induced coagulopathy in adult and pediatric patients. Methods Adult (> 18 years) and pediatric (< 18 years) patients of TBI admitted in the intensive care unit of a trauma center of a tertiary care center had been studied from August 2015 to March 2018. Patients were further subdivided into moderate and severe TBI based on Glasgow Coma Scale (GCS) of 9 to 12 and < 9, respectively. Coagulation profile (prothrombin time [PT], activated partial thromboplastin time [APTT], thrombin time, fibrinogen, and D-dimer) and arterial blood gas (ABG) analysis were done on day of admission and on days 3 and 7. Coagulation profiles were analyzed in both the age groups, and risk factors were studied and correlated with the mortality and morbidity based on the Glasgow outcome score. Results Two hundred patients including 143 adults and 57 pediatric patients were included. Mean age among the adult and pediatric population was 31.51 ± 16.83 and 11.5 ± 5.90 years, respectively. In adults, 96 (83.62%) out of 116 in severe TBI group and 20 (74.07%) out of 27 in moderate TBI group developed coagulopathy, and in pediatric age group, 14 (70%) out of 20 in moderate TBI and 30 (81.08%) out of 37 in severe TBI developed coagulopathy. Midline shift was significantly associated with coagulopathy in both the age groups (p value < 0.039). Mortality was not significantly different in patients with coagulopathy between the age groups, but improved status as per the Glasgow outcome score was more in pediatric age group. Conclusion The development of coagulopathy is a frequent complication in patients with moderate to severe TBI in both age groups. Even though it is not closely associated with death in this study, it may be regarded as a marker of injury severity.

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Results of pulmonary metastasectomy for osteosarcoma in the pediatric age group.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.10080 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 10080-10080

Author(s):

Bassam Redwan ◽

Joachim Schmidt ◽

Benedetta Bedetti ◽

Uta Dirksen ◽

Herbert Juergens ◽

...

Keyword(s):

Overall Survival ◽

Pediatric Patients ◽

Pulmonary Metastases ◽

Pulmonary Metastasectomy ◽

Age Group ◽

Pediatric Age ◽

Free Survival ◽

Pediatric Age Group ◽

Duration Of Surgery ◽

Pulmonary Metastasectomies

10080 Background: Despite multimodal treatment concepts and complete surgical resection, prognosis in pediatric patients with pulmonary metastases from osteosarcoma has remained limited due to frequent relapse of disease. We investigated the results of an aggressive surgical approach. Methods: In a retrospective study, procedures and outcomes of pulmonary metastasectomy in the pediatric age group (up to 18 years) at our institution were analyzed over a period of 10 years (1999-2009). Resection of the primary osteogenic tumor and chemotherapy (CROSS-96-protocol and EURAMOS-1-protocol) were performed prior to thoracic surgery. Results: Forty-five pediatric patients (20 females) underwent pulmonary metastasectomies via sternotomy or sequential anterolateral thoracotomy at a mean age of 14 (6 -18) years. At primary surgery, a mean number of 7.9 (1 – 53) palpable suspicious lesions were resected per patient. Histo-pathological evaluation revealed 3.7 (0 – 40) metastases per patient. Mean total duration of surgery was 152 (46–323) minutes. Mean hospital stay was 10 days (3 – 33). In-hospital and 30-day mortality was 0%. The overall survival at 1 and 5 years was 97.8% and 77.3%, respectively. Mean disease-free-survival was 12.2 (3.2-38.0) months. In 19 (42.2 %) patients recurrent pulmonary metastases were detected and re-thoracotomies were required. Up to 7 procedures per patient were performed. Overall survival for patients undergoing more than one surgical procedure for recurrent lung metastases was not statistically different from survival in patients without relapse (p > 0.05). Survival was significantly better in patients initially presenting with less than 10 metastases (85.3 % vs. 54.1 % at 5 years, p = 0.028). Conclusions: Complete pulmonary metastasectomies are essential in pediatric osteosarcoma patients with lung metastasis. Repeated resections for recurrent relapses improve survival and may allow for long-term event-free-survival.

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Impact of cold dissection tonsillectomy method combined with selective low voltage bipolar diathermy cauterization on the post tonsillectomy pain in the pediatric age group

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194214 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1470

Author(s):

Ramesh Varadharajan ◽

Vaishnav Radhakrishnan ◽

Sneha Suresh ◽

Sreedevi S. Babu

Keyword(s):

Postoperative Pain ◽

Low Voltage ◽

Age Group ◽

Pediatric Age ◽

Bipolar Diathermy ◽

New Techniques ◽

Pediatric Age Group ◽

Post Operative Pain ◽

Mucosal Incision ◽

Cold Dissection

Background: Pediatric tonsillectomies are commonly performed by cold dissection or electro cautery dissection. Both the techniques have been compared in many articles for their role in controlling the post-operative pain and bleeding. With the electro cautery dissection the blood loss is comparatively less, but the post-operative pain is reported as more. Several expensive new techniques are available to address the problems. A simple technique of cold dissection tonsillectomy combined with selective low voltage bipolar diathermy cauterization performed in the pediatric age group is being studied retrospectively for its impact in managing the post-operative pain.Methods: The case records of 73 patients aged 4-15 years who were operated for tonsillectomy from January 2018 to July 2019 are retrospectively studied. 33 patients underwent cold dissection and ligature tonsillectomy and 40 patients underwent tonsillectomy by cold dissection combined with selective low voltage bipolar diathermy cauterization. The postoperative pain incidence in these two groups is studied. Results: The cold dissection tonsillectomy combined with selective low voltage bipolar diathermy cauterization technique was found to be useful in managing the postoperative pain in pediatric tonsillectomies.Conclusions: Performing cold dissection tonsillectomy with precise mucosal incision, gentle dissection and combining it with selective low voltage bipolar diathermy cauterization of the bleeding points was found to be helpful in controlling the postoperative pain in pediatric tonsillectomies. Prescribing a syrup form of NSAID from the second post-operative day was found to be of additional help.

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