Coblation versus bipolar electrocautery tonsillectomy: a comparative study in children

<p class="abstract"><strong>Background: </strong>Tonsillectomy is a commonly done surgery by ENT surgeons all over the world. There are many surgical techniques to do this surgery. This study is aimed to compare intraoperative efficiency and postoperative recovery between coblation and bipolar electrocautery tonsillectomy.</p><p class="abstract"><strong>Methods:</strong> This prospective study was carried out on 60 patients that underwent tonsillectomy over 2 years from February 2019 to January 2021 in Mallareddy Institute of Medical Sciences, Suraram, Hyderabad. The patients were equally divided into two groups; coblation tonsillectomy (30 patients) and bipolar electrocautery tonsillectomy (30 patients). Their age ranged between 4-15 years. The operative time and intraoperative blood loss were recorded for each patient and compared. The parents were given a pain diary to record the level of pain each morning for ten days. Also, they were asked to report any complication like bleeding.</p><p class="abstract"><strong>Results:</strong> There was no statistically significant difference in the mean operation time and intra operative blood loss between the coblation group and bipolar electrocautery group There was a statistically significant difference in the daily pain scores between the two groups in which the coblation group was associated with lower mean pain score. 1 episode of secondary hemorrhage was recorded in bipolar electrocautery tonsillectomy.</p><p class="abstract"><strong>Conclusions:</strong> Bipolar electrocautery tonsillectomy offers the same operative speed, similar intraoperative blood loss, more postoperative pain scores when compared with coblation tonsillectomy.</p>

Interaction Effect of Baseline Serum Glucose and Early Ischemic Water Uptake on the Risk of Secondary Hemorrhage After Ischemic Stroke

Background and Purpose: Intracerebral hemorrhage (ICH) after mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remains a major complication and its early prediction is of high relevance. Baseline serum glucose (BGL) is a known predictor of ICH, but its interaction with early ischemic changes remains uncertain. We hypothesized that BGL interacts with the effect of tissue water uptake on the occurrence of ICH.Methods: Three hundred and thirty-six patients with acute ischemic stroke treated with MT were retrospectively analyzed. ICH was diagnosed within 24 h on non-enhanced CT (NECT) and classified according to the Heidelberg Bleeding Classification. Early tissue water homeostasis has been assessed using quantitative lesion net water uptake (NWU) on admission CT. Multivariate logistic regression was used to identify predictors of ICH.Results: One hundred and seven patients fulfilled the inclusion criteria of which 37 (34.6%) were diagnosed with ICH. Patients with ICH had a significant higher BGL on admission (median 177 mg/dl, IQR: 127–221.75, P &lt; 0.001). In patients with low BGL (&lt;120 mg/dl), higher NWU was associated with 1.34-fold increased likelihood of ICH, while higher NWU was associated with a 2.08-fold increased likelihood of ICH in patients with a high BGL (&gt;200 mg/dl). In multivariable logistic regression analysis, BGL (OR: 1.02, 95% CI: 1.00–1.04, P = 0.01) and NWU (OR: 2.32, 95% CI: 1.44–3.73, P &lt; 0.001) were significantly and independently associated with ICH, showing a significant interaction (P = 0.04).Conclusion: A higher degree of early tissue water uptake and high admission BGL were both independent predictors of ICH. Higher BGL was significantly associated with accelerated effects of NWU on the likelihood of ICH. Although a clear causal relationship remains speculative, stricter BGL control and monitoring may be tested to reduce the risk of ICH in patients undergoing thrombectomy.

Outcome of tonsillectomy in children without the use of postoperative antibiotics at two tertiary care hospitals of Peshawar

Introduction: Overuse of antibiotics can lead to antimicrobial resistance and unnecessary costs. Although early studies reported improved outcomes following use of perioperative antibiotics for tonsillectomy, more recent studies have not been able to demonstrate a significant benefit on post tonsillectomy morbidity. Objective: To determine the need for postoperative antibiotics in children undergoing tonsillectomy under aseptic conditions at two tertiary care hospitals of Peshawar. Materials & Methods: Children aged 5-14 years admitted to the departments of Otorhinolaryngology-A unit of Hayatabad Medical Complex and Rehman Medical Institute, Peshawar from March 01, 2018 to September 30, 2018 for recurrent sore throat and recurrent quinsy were included in this quasi-experimental study based on prospective data collection and convenience sampling. Children with blood dyscrasias, upper and lower respiratory tract infections, and cardiopulmonary diseases were excluded. Routine preoperative investigations were done, and all were given postoperative analgesics. The patients were divided into two consecutive groups of 60 each; Group-A was given Co-amoxiclav 20mg/5mg/kg/day for 10 days and Group-B was not given any antibiotic. During their stay in the hospital and on follow up they were asked about pain via Visual Analogue Scale, and presence of fever and/or bleeding were documented. Results: Of 120 children, 50 (41.6%) were males and 70 (58.4%) were females, of ages 05-14 years; 01(1.6%) from Group-A and 01(1.6%) from Group-B presented with reactionary hemorrhage. However, 01(1.6%) from Group-A and 25(40%) from Group-B presented with secondary hemorrhage for which they were readmitted and put on injectable antibiotics. Similarly, 05(8.3%) from Group-A and 14(23.3%) from Group-B presented with pain for which pain killers were prescribed. Conclusion: Post tonsillectomy antibiotics may have a role in reducing the morbidities associated with the procedure in our setup. Keywords: Tonsillectomy; Postoperative Infections; Antibiotic Resistance; Hemorrhage.

Recurrent Hemorrhage from Intermittent Pneumatic Compression Device Use After the Removal of a Femoral Venous Catheter—A Case Review

Highlights Abstract Intermittent pneumatic compression (IPC) is an effective method for preventing deep vein thrombosis (DVT) and is comparatively low risk for hemorrhaging compared with anticoagulant therapy. IPC is easily administered, and severe complications are rare. The patient was a 69-year-old male with no underlying diseases related to hemorrhaging of hemostasis. He was hospitalized for treatment of a third-degree burn injury to the upper body. Because the treatment included surgical debridement and skin grafting, there was substantial concern regarding the potential of hemorrhagic complications; hence, IPC was initiated to prevent DVT rather than standard anticoagulant therapy. On the ninth day of hospitalization, a femoral venous catheter initially placed to manage hydration was removed. Manual compression was performed for 15 minutes, and after confirming hemostasis at the insertion site, a hemostasis band was applied for an additional hour. At 90 minutes after confirming hemostasis, there was a secondary hemorrhage at the site of catheter removal. The secondary hemorrhage was stopped with manual compression, and IPC was discontinued. It was concluded that IPC might result in increased blood flow in the femoral vein. This may have contributed to the secondary hemorrhage after the removal of the catheter. Clinicians need to be aware of the fact that IPC may promote secondary hemorrhage after removal of a femoral venous catheter.

Abstract P414: Outcomes of Incident Hemorrhage From Cranial Dural Arteriovenous Fistulae: Analysis of the Multi-Center International Condor Registry

Introduction: Dural artertiovenous fistulae (dAVF) are rare causes of secondary intracranial hemorrhage (ICH) and there remains a paucity of knowledge regarding their natural history. To date our knowledge comes from small case series. CONDOR, (Consortium for Dural Arteriovenous Fistula Outcomes Research), a large multi-institutional retrospective registry, provides a unique opportunity to evaluate the outcomes of patients presenting with dAVF related hemorrhages. Methods: We performed a retrospective review of 1077 dAVF patients from the CONDOR registry and selected those patients who presented with hemorrhage secondary to the dAVF. Patient characteristics, clinical presentation/follow-up, and radiographic details were analyzed for associations with patient outcomes. An outcome of mRS 0-2 was categorized as a “good” outcome and 3-6 as “poor”. Statistics were performed in SAS 9.4 with chi square, fisher’s exact test, and stepwise select variable multivariate analysis; P<.05 was marked as the level for statistical significance. Results: Evaluation of the CONDOR dataset yielded 267 patients who presented with hemorrhage. The mean age of the population was 59 ±13y.o, 30% were female, 40% had a history of smoking and 93% were not on anticoagulants. The median follow-up was 1.4 years. The mortality was 4.0 % at follow-up, and 83% of patients had a good outcome (mRS 0-2). Univariate analysis found age (p=0.001), anticoagulant use (p=0.006), and presentation mRS (p=0.03) were associated with poor outcome at follow-up. Subtype of hemorrhage (parenchymal hemorrhage or subarachnoid hemorrhage), smoking, and cortical venous shunting of the lesion, (i.e. Cognard grade IIb and greater) did not reach statistical significance. On multivariate analysis age (p=0.023) and mRS (p=0.035) at presentation but not anti-coagulant use (p=0.11) was associated with follow-up mRS. Conclusion: Within the largest individual patient series to date, we found that dAVF presenting with hemorrhage was associated with a relatively low risk of mortality. Age and mRS at presentation were most strongly predictive of outcome. Our results suggest that dAVF hemorrhage may be associated with a less morbid outcome than other forms of secondary hemorrhage.

Daflon use for reducing post-tonsillectomy pain and hemorrhage: a prospective study

Background Tonsillectomy usually was a safe procedure; in adults, the risk of agonizing pain and secondary hemorrhage could be serious. We introduced Daflon as a safe and effective complementary medication in reducing these risks. This prospective study was designed to evaluate the effect of using (Daflon oral medication) on post-tonsillectomy pain and hemorrhage rates. This study was conducted on 60 patients of both sexes, above 21 years, and underwent tonsillectomy using bipolar diathermy. Patients were randomly distributed between 2 groups; each group has 30 patients and with the same post-operative protocol; in group 2, an addition of Daflon 500 mg tablet twice daily for 14 days post-operatively was given. Results In group 2, agonizing pain start day, pain duration, analgesia duration, and need for another type, all were significantly different from group 1, starting day in group 1 (4.3 ± 4.0) and (7.2 ± 1.3) in group 2, pain duration in group 1 (7.3 ± 1.5) and (4.2 ± 1.4) in group 2 and need for more analgesia 80% in group 1 and 50% in group 2. Post-operative hemorrhage was 4 cases (13.3%) in group 1, and 2 cases (7%) in group 2, also severity of post-operative bleeding were less in group 2. Healing membrane detaching time was (12.2 ± 2.2) in group 1 and (9.1 ± 1.9) in group 2. Conclusion The use of Daflon 500 mg tablet after bipolar tonsillectomy added to effectiveness of pain control also could help in reducing bleeding rates and its severity. Overall, its use enhances recovery and improves quality of life.

EFFICACY OF STEROID AND PROTON PUMP INHIBITORS IN PATIENTS UNDERGOING TONSILLECTOMY - A COMPARATIVE STUDY

INTRODUCTION: All tonsillectomy techniques share the same characteristics of producing an avulsion wound exposing the underlying tissues which requires extensive healing by secondary intention. our study aims to compare two pharmacological agents and analyze their clinical outcome in post operative recovery of tonsillectomy patients. MATERIALS AND METHODS: Patients were randomly divided into two groups- Group A and Group B. Group A received Injection Dexamathasone, while group B received oral pantoprazole. Post operatively patients were assessed for post operative pain, wound healing and incidence of secondary hemorrhage on Post operative Day (POD) 0, 1, 7, 14. RESULTS: Group A (steroid) had comparatively less pain on POD 0 and POD 1. However there was no significant differnence between both the groups on POD 7 and 14. Incidence of secondary haemorrhage was seen in Group A (2%), but no incidence of haemorrhage was recorded in Group B. Both the groups did not show statistically significant difference in regards to wound healing. DISCUSSION: Tonsillectomy as a surgical procedure has evolved over the years. Our study took into account two pharmacological agents, dexamethasone and pantoprazole which act by different mechanism and measured their clinical outcomes in managing post tonsillectomy patients. CONCLUSION: The study concluded that there was no significant statistical difference between the two drugs in alleviating postoperative pain, wound healing and secondary haemorrhage.

Comparison of Early versus Interval Tonsillectomy in Cases of Peritonsillar Abscess

Objective: To compare early versus interval tonsillectomy in cases of peritonsillar abscess.Study Design: Comparative study.Place and Duration of Study: The study was carried out at ENT Department of Combined Military Hospital, Mardan from January 2017 to January 2018.Materials and Methods: A total 50 patients were selected from ENT outpatient department. All the cases were randomly divided into two groups of 25 each. Group A underwent early tonsillectomy after initial incision and drainage, Group B underwent interval tonsillectomy after 6 weeks. Both the groups were compared in terms of perioperative blood loss, operation time, ease of dissection and postoperative complications including pain and hemorrhage. Tonsillectomy was done with bipolar cautery in all the cases.Results: The mean age was 30.22 + 8.25. Out of 50 patients, 42 (84%) were males and 8 (16%) were females. The mean operative time of surgery in group A (early tonsillectomy) was 45.04+5.78 minutes compared to 32.72+4.37 minutes for group B (interval tonsillectomy (p=0.00). Mean post-operative pain in group A was 3.68+2.12 compared to group B where mean score was 3.36+1.93 (p=0.579). There were 3 cases of mild perioperative blood loss, 19 cases of moderate and 3 of severe perioperative blood loss in group A. There were 18 cases of mild perioperative blood loss, 7 cases of moderate and no case of severe perioperative blood loss in group B (p=0.00). Dissection was found to be significantly easier in group B (interval tonsillectomy). There were 7 cases of post-op secondary hemorrhage in group A compared to 3 in group B (p=0.289). All these cases of secondary hemorrhage were managed conservatively.Conclusion: Interval tonsillectomy is a safer procedure as compared to early tonsillectomy in terms of perioperative blood loss, operative time, dissection with almost similar post-op pain and similar risk of post tonsillectomy hemorrhage. How to cite this: Khan MA, Ahmed A, Khan M. Comparison of Early versus Interval Tonsillectomy in Cases of Peritonsillar Abscess. Life and Science. 2020; 1(1): 24-28. doi: https://doi.org/10.37185/L&S.1.1.13