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Obstructive Sleep Apnoea
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
There is increasing interest in drug-induced sleep endoscopy (DISE). The child is given a titrated dose of an anaesthetic agent (usually propofol) and the surgeon passes a flexible endoscope to observe the movements of the tongue, palate and pharyngeal muscles. The technique is especially helpful in children who have had adenotonsillectomy but present with residual symptoms. Adenoidal remnants, tongue base or pharyngeal wall prolapse and, in some cases, laryngomalacia may be picked up in this way.
Adenotonsillar Conditions and Obstructive Sleep Apnoea
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
The Childhood Adenotonsillectomy Trial randomized children to early adenotonsillectomy or watchful waiting. Neuropsychological outcomes showed no difference; however, PSG findings and quality of life were significantly improved for the treatment arm.
Oropharynx
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Adenotonsillar hypertrophy results in nasal and Eustachian tube obstruction leading to mouth breathing, nasal congestion, hyponasal speech, snoring, obstructive sleep apnoea, chronic sinusitis and recurrent otitis media [11]. Adenotonsillar hypertrophy is the most important anatomical factor that has been associated with obstructive apnoea [12]. This syndrome is associated with several adverse outcomes, including cognitive impairment, metabolic and cardiovascular consequences, behavioural deficits and lower quality of life (QoL) [13]. Though not curative in all patients, the impact of adenotonsillectomy on these conditions can only be estimated prior to surgery and ascertained following surgery. With judicious patient selection, adenotonsillectomy results in improvement in most key outcomes [14].
The beneficial effects of an adenotonsillectomy upon upper respiratory tract infections, asthma and rhinitis in children: a national database study in Korea
Published in Acta Oto-Laryngologica, 2023
Mi Rye Bae, Kyung-Do Han, Sang-Hyun Park, Yoo-Sam Chung
Adenotonsillectomy is the most frequently performed otolaryngology surgery in children. This procedure is the first-line treatment for children with obstructive sleep disorder and is also performed in pediatric cases of recurrent tonsillitis, otitis media, or rhinosinusitis that have not responded to appropriate medical treatment [1]. Despite the high frequency of adenotonsillectomy, the effectiveness of the surgery has not yet been established. Some studies reported a reduction in recurrent throat infection in children after tonsillectomy but these were limited by the small number of data [2,3]. Kohli’s systematic review concluded that asthma severity markers decreased after adenotonsillectomy with the remark of the paucity of included studies [4]. Several other studies that have shown adenoidectomy to improve symptoms of chronic rhinitis have indicated the difficulty of distinguishing symptoms of adenoid vegetation and rhinitis [5,6].
Effective hemostasis in children with Von Willebrand factor defects undergoing adenotonsillar procedures
Published in Pediatric Hematology and Oncology, 2020
Rosa Diaz, MaryFrances Musso, Donald Mahoney
In the past 10 years, 4 case series have evaluated the incidence of postoperative bleeding in patients with VWD undergoing adenotonsillectomy (Table 5).6,10–12 All of these publications included the use of DDAVP and an antifibrinolytic (EACA or TXA). However, they varied in duration and frequency of dosing. None of the studies reported episodes of immediate bleeding and the rate of delayed bleeding ranged from 0 to 17%. Comparison among these studies is challenging due to differences in the diagnosis of VWD, definition of bleeding and surgical techniques. Additionally, 2 other studies reported delayed bleeding rates of 15% (and as high as 35% in children ≥ 16 years of age) in patients with bleeding disorders including, but not limited to, patients with VWD undergoing adenotonsillar procedures.14,15
Ketofol performance to reduce postoperative emergence agitation in children undergoing adenotonsillectomy
Published in Libyan Journal of Medicine, 2020
Idress Ali, Murad Alahdal, Haifa Xia, Arafa S. El. Moughrabi, Huang Shiqian, Shanglong Yao
On the other hand, propofol-ketamine combinations have been used for practical sedation [18] in comparison to ketamine and propofol with propofol alone in the emergency department by many projects, but the optimum mixing concentrations for children’s sedation yet have not been judged. Ketofol advantages could be reduced or giving reverse interaction if the effect of ketamine and propofol does not well balanced. According to the previously published literature, we noticed that ketamine to propofol 1:3 ratio was reduced emergency agitation’s serious complications and provide better results in children in comparison to other mixing ratios [19]. Thus, we supposed that using a 1:3 mixing ratio could be the best choice for our sedation applications. However, until now children’s age groups that have been documented showed a range between 6 months and 10 years, since most of the children undergo adenotonsillectomy operations are school-aged children more than documented ages. Therefore, in this study we report children from 3 to 15 years old underwent emergency adenotonsillectomy those were received ketofol (1:3) induced and maintained with sevoflurane. We also discussed the clinical significance of ketofol for this category of children in comparison to the non-ketofol sedated group.