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61.
《Sleep medicine》2020
ObjectiveLimited information is currently available on 24-h ambulatory blood pressure (ABP) changes after adenotonsillectomy (T&A) in children with obstructive sleep apnea (OSA). In this study, the trajectory of 24-h ABP changes after surgery in children with OSA was examined at three-month and six-month follow-up.MethodsChildren aged 4–16 years with clinical symptoms of OSA and polysomnography (PSG)-diagnosed OSA (apnea-hypopnea index [AHI] >1) were included. All the children received T&A. PSG was conducted before and after surgery. Twenty four hour ABP was monitored using the linear mixed model before, three months after, and six months after surgery.ResultsIn total, 122 children were examined (mean age: 7.9 years; 71% were boys). The AHI significantly decreased from 12.7 ± 16.7 to 2.4 ± 3.2 events/h after T&A (P < 0.001). Overall diastolic blood pressure (DBP; from 65.1 to 63.4 mmHg, P = 0.01) and night-time DBP (from 57.4 to 55.4 mmHg, P = 0.032) decreased nonsignificantly during the six-month postoperative period. The OSA children with presurgical hypertension exhibited significant reductions in overall systolic blood pressure (SBP), overall DBP, daytime DBP, night-time SBP, and night-time DBP at the three-month and six-month postoperative follow-up (all P < 0.05). The three-month and six-month ABP data did not differ significantly in the entire cohort, even between children with presurgical hypertension and non-hypertensive children.ConclusionThe 24-h ABP decreased significantly in the OSA children with hypertension at three and six months after surgery. Moreover, ABP findings did not differ significantly between the three- and six-month follow-up. 相似文献
62.
《Sleep medicine》2021
BackgroundThe impact of removing the upper airway lymphoid tissue and in particular, tonsillectomy, in adults with OSA has not been demonstrated in large populations.AimsTo compare the severity of OSA and the prevalence of cardiovascular, metabolic and respiratory co-morbidities between patients with OSA who had undergone previous tonsillectomy and those who had not.MethodsThe 19,711 participants in this study came from the European sleep apnea database (ESADA) which comprises data from unselected adult patients aged 18–80 years with a history of symptoms suggestive of OSA referred to sleep centers throughout Europe.ResultsThere were no differences between the two groups in terms of sex ratio and age (146 patients with previous tonsillectomy vs. 19565 patients without). Patients who had undergone tonsillectomy had a lower body mass index (29.3 ± 5.2 kg/m2 vs 32.2 ± 6.6 kg/m2, p < 0.001), lower subjective sleep latency (17.1 ± 17.8 min vs 25.5 ± 30.4 min, p = 0.001), lower ODI (15.7 ± 18.3 events/hour vs 30.7 ± 26.1 events/hour, p < 0.001), and SpO2<90% time during sleep (21.8 ± 47.5 min vs 52.6 ± 80.8 min, p < 0.001). OSA patients with tonsillectomy had a lower prevalence of Type II diabetes mellitus (p = 0.001), hypertension (p < 0.001) and a higher prevalence of hyperlipidemia (p < 0.001) and were less likely to be commenced on CPAP (p < 0.001).ConclusionIn a large population of almost 20,000 OSA patients from across Europe, patients who had undergone tonsillectomy presented with less severe OSA at time of diagnosis, and had a lower prevalence of Type II diabetes mellitus and cardiovascular co-morbidities. 相似文献
63.
《Revista brasileira de otorrinolaringologia (English ed.)》2020,86(4):427-433
IntroductionTonsillectomy is one of the most common surgeries in the head and neck worldwide. This operation is carried out by different methods, the most frequent of which are the cold dissection and bipolar electrocautery techniques.ObjectiveThis study was conducted to assess and compare postoperative morbidity between cold dissection and bipolar electrocautery.MethodsThis prospective randomized clinical trial was performed on 534 patients who underwent tonsillectomy in Vali-e-Asr Hospital of Birjand, east of Iran from October, 2013 to October, 2015. The patients were systematically selected for cold dissection technique or bipolar electrocautery technique groups. Time of surgery, amount of intraoperative blood loss, postoperative hemorrhage, the intensity of local pain 4 and 24 hours after operation and nausea and/or vomiting were recorded and compared in the two groups to decide which technique is better. The data were analyzed in SPSS software (ver-22). The p-value less than 0.5 was considered significant.ResultsIn this study, 51.7% of the cold dissection technique patients and 50.6% of the bipolar electrocautery technique participants were male. Compared to the cold dissection technique, the average intraoperative blood loss was significantly lower (p < 0.001) in the bipolar electrocautery technique group, while the intensity of local pain 4 and 24 hours after the operation was significantly higher (p < 0.001). Other variables showed no significant differences between the two groups.ConclusionBased on the findings of the present investigation, the bipolar electrocautery technique is suggested for tonsillectomy in children, while the cold dissection technique is preferred for adult patients. 相似文献
64.
65.
Min-Su Kim Hyo Geun Choi Eun-Kyu Park So Young Kim Jin-Hwan Kim Bumjung Park 《Auris, nasus, larynx》2018,45(3):508-513
Objective
The aim of this study was to determine the natural course of pain after tonsillectomy.Methods
This study included 119 patients that underwent tonsillectomy between November 2013 and November 2015. After undergoing tonsillectomy, patients scored their pain using the visual analogue scale three times daily (morning, midday, and evening) for 2 weeks. A linear mixed model was used for statistical analyses.Results
Increasing postoperative days was negatively associated with pain following tonsillectomy surgery (estimated value [EV] of visual analogue score [VAS]/day = ?0.42, 95% confidence interval [CI] = ?0.43 to ?0.41, P < 0.001); the post-tonsillectomy pain curve illustrated this negative correlation. Postoperative pain was less in children and adolescents (≤18 years old) than in adults (>18 years old) (EV = ?0.81, 95% CI = ?1.56 to ?0.08, P = 0.031). Mean tonsillectomy-associated pain on postoperative day 1 was 6.4 VAS. It decreased slightly to 5.3 VAS until postoperative day 7, after which it reduced sharply to 3.7 VAS within 3 days; on postoperative day 14 it had decreased to 1.6 VAS. Pain assessments were higher in the morning (EV = 0.59, 95% CI = 0.50 to 0.69, P < 0.001) compared with assessments conducted in the evening.Conclusion
The natural course of postoperative tonsillectomy pain follows a gradual decline for 1 week after surgery, but decreases more rapidly after this period. 相似文献66.
Mika Adachi Mitsuhiro Sato Mariko Miyazaki Osamu Hotta Koji Hozawa Toshinobu Sato Yoshio Taguma Yukio Katori 《Auris, nasus, larynx》2018,45(6):1206-1213
Objective
Tonsillectomy combined with steroid-pulse therapy is a widely accepted method for the treatment of IgA nephropathy (IgAN) in Japan. However, the indication of tonsillectomy for IgAN is still controversial, and the timing of tonsillectomy is not clearly defined for the protocol of this therapy. Based on the results of a randomized control trial in Japan, the Evidence-Based Clinical Practice Guidelines for IgA nephropathy 2014 (edited in Japan) recommended tonsillectomy combined with steroid-pulse therapy for Grade C1. However, this is not widely accepted worldwide. To clarify the validity and timing of tonsillectomy, we evaluated how the three-consecutive steroid-pulse therapy method affects the tonsil tissues of IgAN patients.Methods
We examined tonsil specimens from 35 IgAN patients and 8 chronic tonsillitis patients. We compared the proportion of follicular area to total tonsillar area and the number of germinal centers between each group on hematoxylin and eosin stained pathological specimens to clarify the histopathological characteristics of tonsils from IgAN patients. Based on these findings, we examined the tonsils of patients after three-consecutive steroid-pulse therapy treatments (n = 34) to determine the influence of this therapy on the tonsil tissues of IgAN patients. Moreover, we observed chronological changes in tonsil tissues after steroid-pulse therapy.Results
The extrafollicular area was enlarged in IgAN patients before steroid-pulse therapy compared with chronic tonsillitis patients. Just after steroid-pulse therapy, the follicles became very small with blurry outlines, and the number of germinal centers was remarkably decreased. With a gradual decrease in oral prednisolone, the tonsil tissue structure was gradually restored.Conclusion
Tonsillectomy combined with steroid-pulse therapy is considered a reasonable treatment for IgAN. Steroid-pulse therapy-induced histological changes in tonsils were transient, indicating tonsillectomy should be performed before or just after steroid-pulse therapy. 相似文献67.
68.
69.
The widespread use of day case surgery for minor operations in children places increased emphasis on home care, parental responsibility and attention to suitable analgesia. This study evaluated a training program for doctors and nurses on postoperative analgesia in children by following up parental perceptions of pain relief after discharge. The main objective of our study was to determine the effects of a training program on treatment practices in the hospital and on the home care instructions provided. The study was carried out in two phases. A questionnaire was sent to parents of children aged under 8 years who had undergone a minor otorhinolaryngological operation (tonsillectomy, adenoidectomy, irrigation of maxillary sinus, insertion of grommets, or paracentesis) at the Day Case Unit in Kuopio University Hospital. The parents of 115 children returned the questionnaire in the preintervention study and those of 112 children in the postintervention study (response rates: 79% and 86% respectively). The training program for personnel (intervention) was organized between the two studies. It started with a onehour lecture on postoperative pain and pain treatment in children, and the lecture was followed by two weeks of bedside teaching. The overall standard of pain treatment in the hospital was good. Most of the children had no pain or only mild pain on discharge (93% before the intervention and 90% after the intervention). The intervention had no effect on the likelihood of children receiving pain medication. Noticeable changes occurred in the selection of pain medicines and dosage forms, and in the increased number of home care instructions provided for parents. We conclude that the training program for both professional groups (doctors and nurses) can be beneficial in changing the treatment practice (especially the use of medicines and dosage forms). Such training programs also make it possible to emphasize the importance of proper instructions for home care and thus to improve the quality of information provided for parents. 相似文献
70.
目的评价格拉司琼复合地塞米松用于预防小儿扁桃体剥离术后呕吐的效果。方法拟在气管内全麻术下行扁桃体剥离术的小儿80例,随机分为4组:地塞米松(A组),格拉司琼组(B组),格拉司琼复合地塞米松组(C组),对照组(D组)。观察术毕至术后24h呕吐的发生情况及严重程度,记录24h清醒状态及不良反应。结果各组患儿年龄、性别、体重、麻醉时间等各组间比较差异无统计学意义(P〉0.05),与D组相比,A、B、C组的术后呕吐发生率、严重程度明显降低(P〈0.05),C组的发生率最低。结论地塞米松和格拉司琼对预防小儿术后呕吐都有一定作用,但两者合用能更好地起到预防小儿术后呕吐的作用。 相似文献