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Tonsillectomy Under the Microscope: Is Routine Histopathological Analysis Necessary?
Cureus
October 2024
Department of Otolaryngology-Head and Neck Surgery, Hamad Medical Corporation, Doha, QAT.
Introduction Tonsillectomy is the most common surgery in otorhinolaryngology worldwide, with many indications in adults and children. Traditionally, all tonsillectomy specimens are routinely submitted for histopathological examination, even in the absence of clinical suspicion of malignancy. This practice has been debated due to its resource implications and the low yield of malignancy in routine cases.
View Article and Find Full Text PDFOptimizing pediatric tonsillectomy outcomes with an opioid sparing anesthesia protocol: Learning and continuously improving with real-world data.
Paediatr Anaesth
November 2024
Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Washington, USA.
Introduction: This quality improvement initiative is a continued pursuit to optimize outcomes by iteratively improving our opioid sparing anesthesia protocol for tonsillectomy with or without adenoidectomy at our pediatric ambulatory surgical center through data driven Plan-Do-Study-Act cycles.
Methods: From 1/2015 through 12/2023, our standardized tonsillectomy protocol underwent nine procedure-specific perioperative Plan-Do-Study-Act cycles, three procedure-specific postoperative prescription Plan-Do-Study-Act cycles, and four general ambulatory surgical center enhanced recovery Plan-Do-Study-Act cycles. We analyzed data from the medical record using statistical process control charts.
Effects of dexamethasone on opioid consumption in pediatric tonsillectomy: a systematic review with meta-analysis.
Can J Anaesth
August 2024
Department of Anesthesia and Pain Medicine, The Hospital for Sick Children (SickKids), Toronto, ON, Canada.
Purpose: Tonsillectomy is one of the most common ambulatory procedures performed in children worldwide, with around 40,000 procedures performed in Canada every year. Although a prior systematic review indicated a clear role for dexamethasone as an analgesic adjunct, the quantity effect on opioid consumption is unknown. In the current systematic review with meta-analysis, we hypothesized that the use of dexamethasone reduces perioperative opioid consumption in pediatric tonsillectomy but does not increase rates of postoperative hemorrhage.
View Article and Find Full Text PDFOvernight Monitoring Criteria for Children with Obstructive Sleep-Disordered Breathing After Tonsillectomy: Revisited.
Laryngoscope
December 2024
Department of Otolaryngology-Head & Neck Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A.
Objectives: Previous studies indicate children who pass an Asleep Room Air Challenge (AsRAC) do not have significant postoperative adverse respiratory events after adenotonsillectomy (T&A). Subsequently, we revised our overnight monitoring (OM) criteria, allowing patients with an obstructive apnea/hypopnea index (OAHI) ≤20 or nonsevere obesity (Class I) to be considered for same-day surgery (SDS) if they passed an AsRAC. Our hypothesis is that our modified OM criteria would not increase the return visits or readmission rates for patients undergoing SDS within 48 h or 15 days of T&A.
View Article and Find Full Text PDFHow Do We Safely Increase Day-Case Tonsillectomy for the Treatment of Paediatric Obstructive Sleep Apnoea-A Cohort Analysis.
Clin Otolaryngol
November 2024
Department of Paediatric Otolaryngology, Great North Children's Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
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