Surgeons' exposure to sevoflurane during paediatric adenoidectomy: a comparison of three airway devices

Although sevoflurane is commonly used in anaesthesia, a threshold value for maximum exposure to personnel does not exist and although anaesthetists are aware of the problem, surgeons rarely focus on it. We used a photo‐acoustic infrared device to measure the exposure of surgeons to sevoflurane during paediatric adenoidectomies. Sixty children were randomly allocated to laryngeal mask, cuffed tracheal tube or uncuffed tracheal tube. The average mean (maximum) sevoflurane concentrations within the surgeons' operating area were 1.05 (10.05) ppm in the laryngeal mask group, 0.33 (1.44) ppm in the cuffed tracheal tube group and 1.79 (18.02) ppm in the uncuffed tracheal tube group, (p < 0.001), laryngeal mask and cuffed tracheal tube groups vs. uncuffed tube group. The presence of sevoflurane was noticed by surgeons in 20% of cases but there were no differences between the groups (p = 0.193). Surgical and anaesthetic complications were similar in all three groups. We conclude that sevoflurane can be safely used during adenoidectomies with all three airway devices, but in order to minimise sevoflurane peak concentrations, cuffed tracheal tubes are preferred.     

A prospective study of day case adenoidectomy

Adenoidectomy in this country is typically performed as an in-patient procedure requiring an overnight stay in hospital but experience from other countries shows that adenoidectomy can be safely performed as a day case procedure. In Leicester, a prospective study of day case adenoidectomy was initiated in 1991 under carefully monitored conditions. We report on 721 patients entered in the first 3 years. We have so far found day case adenoidectomy to be a safe procedure.     

Suitability of children for ENT day case procedures

This prospective study evaluates the suitability of 500 children under 12 years of age, using both medical and social criteria, to determine the proportion of children suitable for increasing the scope of ENT operations performed as day cases. Co-existing medical conditions that could interfere with both surgery and anaesthesia were found in 39 (8%). A combination of adverse social and domestic conditions, including the number of adults and children resident, number of bedrooms and individuals sleeping in the child's bedroom, the number of cars, and the presence of a telephone, were present in 171 (34%) of children's homes and were almost exclusively found in National Health Service (NHS) patients. Private patients, 31 (6%), were more suitable for day surgery. Guidelines need to be followed to minimize the risk if the number of procedures is increased. If more patients were treated privately, the proportionate number of patients requiring in patient care would rise in the National Health Service.     

A prospective trial of unilateral grommets for bilateral secretory otitis media in children

Fifty-four children with established chronic secretory otitis media, who had failed to respond to medical measures were treated with adenoidectomy and insertion of 1 grommet on a side chosen at random. Both sides improved and remained significantly improved at 12 months (P <0.001). At 3 months, the side with the grommet improved significantly more than the other side (P <0.05) but at 12 months there was no significant difference between the 2 sides (P< 0.1).     

Chronic snoring and obstructive sleep apnea syndrome in children

Increased upper airway resistance during sleep may lead to heavy snoring and/or obstructive sleep apnea in infants and children. Clinical symptoms will be seen with increased upper airway resistance during sleep, even without obstructive sleep apnea or significant oxygen saturation drop. It may be responsible for apparent life threatening events (ALTE). Mild cranio-facial morphometric changes are often associated with increased upper airway resistance during sleep, and there is a continuous interaction between airway patency during sleep and maxillo-mandibular growth. Nasal CPAP can be as much a diagnostic tool as a treatment procedure. Orthodontic and surgical approaches may also be combined in the treatment of this significant health problem.     

Droperidol decreases the incidence and the severity of vomiting after tonsillectomy and adenoidectomy in children

We assessed the effect of intravenous droperidol on the incidence and the severity of postoperative vomiting in children undergoing tonsillectomy and adenoidectomy. Seventy-nine ASA physical status I or II children aged 1.5 to 18 years (mean 6.1 years) were randomized into two groups. Group I received droperidol 50 μg·kg^?1 i.v. (maximum 1.25 mg), while group II received saline placebo immediately following the induction of general anaesthesia. All episodes of vomiting were recorded from the time of extubation until discharge the next morning. Of the 35 assigned to group I only 16 (46%) had one or more episodes of emesis compared to 31 of 44 (71%) in group II (P < 0.05). Patients in group I who vomited, did so only 1.9 ± 1.2 times compared to 4.6 ± 3.8 times for the control patients (P < 0.01). The authors conclude that droperidol at a dose of 50 μg·kg^?1 given at the time of induction of anaesthesia to healthy children decreases the incidence and the severity of vomiting during the first postoperative day following tonsillectomy and adenoidectomy.;     

Revision adenoidectomy--a retrospective study

BACKGROUND: Adenoid "re-growth" is a poorly understood phenomenon. While parents often express concerns regarding the potential for adenoid "re-growth", little information exists in the literature about its incidence and causation. PURPOSE: To establish the incidence and possible contributing factors leading to adenoid re-growth in children. DESIGN: Retrospective case series review. SETTING: Tertiary care children's hospital. METHODS: The charts of 106 patients who underwent revision adenoidectomy between 1995 and 2006 were reviewed. Thirty-four patients were excluded because the primary adenoidectomy was performed elsewhere or initially only a partial adenoidectomy was performed. In the remaining 72 patients, demographic data, clinical presentation, associated medical conditions and findings at surgery were studied. RESULTS: During the 11-year study period. 13,005 adenoidectomies or adenotonsillectomies were performed; 72/13,005 (0.55%) underwent revision adenoidectomy. The mean (+/-S.D.) age at presentation for primary adenoidectomy was 3.68+/-2.9 and 7.69+/-4.04 years for secondary ("revision") adenoidectomy with an average time interval of 4.3 years between surgeries. Age at initial adenoidectomy was not a significant factor in predicting revision adenoid surgery. 29/72 (40%) underwent a reflux work up including scintiscan with gastric emptying, 24h pH probe, or laryngoscopy. 28/29 (96%) were diagnosed with reflux. At least 15/72 (21%) were reported to have symptoms consistent with adenoid re-growth which were found to be caused by tubal tonsil hyperplasia. CONCLUSIONS: Revision adenoidectomy rarely needs to be performed. Tubal tonsillar hyperplasia, as opposed to re-growth of residual adenoid tissue previously removed, accounts for some cases. Extraesophageal reflux is a possible cause in some and requires further study.     

Long-term effect of adenotonsillectomy on quality of life in pediatric patients

HYPOTHESIS: Adenotonsillectomy improves general and disease-specific quality of life for properly selected patients suffering for upper airway obstruction secondary to adenotonsillar hypertrophy (UAO) and obstructive sleep apnea (OSA). STUDY DESIGN: Prospective, nonrandomized questionnaire. SPECIFIC AIMS: To evaluate quality of life in patients with UAO and OSA using general quality of life instruments as well as disease-specific instruments. The results will be compared both pre- and postoperatively. METHODS: Fifty-five patients aged 2 to 16 with the clinical diagnosis of UAO or OSA were recruited. The caregivers completed Children's Health Questionnaire Parent Form-28 (CHQPF-28) and OSA-18 quality of life measures both pre- and postoperatively in the long and short term. Statistical analysis was performed using the unpaired Student t test, P value less than.05, and Spearman Rank coefficient. RESULTS: CHQ-PF28 scores were improved in the Physical Summary parameter in long-term follow-up. Psychosocial scores did not improve significantly. OSA-18 scores showed improvement in both the short-and long-term scores. Physical findings and symptoms did not impact scores in any domain. CONCLUSIONS: Quality of life in children with OSA does improve after adenotonsillectomy. Disease-specific clinometric instruments show improvement in domains affected by the disease process. However, instruments used to assess general quality of life may show physical improvement but not psychosocial.     

腺样体切除术对儿童分泌性中耳炎疗效影响分析

目的 分析腺样体切除术对儿童分泌性中耳炎鼓膜切开置管术后的疗效影响.方法 将127例分泌性中耳炎患者(213耳)随机分成两组:实验组64例(110耳)分泌性中耳炎患者行腺样体切除术 鼓膜切开置管术治疗,对照组对63例(103耳)患者行单纯鼓膜切开置管术治疗,术后随访6～9月,比较两组疗效.结果 实验组治愈63耳,治愈率为57.3%,好转36耳,好转率为32.7%,总有效率为90%;对照组治愈42耳,治愈率为40.8%,好转40耳,好转率为35.8%,总有效率为79.6%,两组总有效率差异有显著性(P＜0.05).结论 腺样体切除术合并鼓膜切开置管术对儿童分泌中耳炎愈后有积极作用.