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Otolaryngology, ENT & Sinus News Provided by the California Sinus CentersDexamethasone Administration and Postoperative Bleeding Risk in Children Undergoing Tonsillectomy [Original Article]August 1, 2010, 12:00 pm by Archives of Otolaryngology Head & Neck SurgeryObjective To assess whether administration of dexamethasone during tonsillectomy is associated with a dose-dependent increased rate of postoperative tonsillectomy hemorrhage. Design Retrospective review of 2788 children and adolescents who underwent tonsillectomy with or without adenoidectomy for sleep-disordered breathing or infectious tonsillitis and received perioperative dexamethasone between January 1, 2002, and March 3, 2009. Patients underwent 1 of 3 methods of tonsillectomy, including extracapsular electrosurgical tonsillectomy, extracapsular radiofrequency ablation tonsillectomy, or intracapsular microdebrider tonsillotomy. Setting Massachusetts Eye and Ear Infirmary. Patients Two thousand seven hundred eighty-eight children and adolescents aged 2 to 18 years (hereinafter referred to as children) who underwent tonsillectomy with or without adenoidectomy. Interventions Each child received 1 of 2 distinct intravenous doses of perioperative dexamethasone (0.5 mg/kg or 1.0 mg/kg) based on the protocol of the surgeon who performed the tonsillectomy; other aspects of care, including anesthetic technique, perioperative analgesia, and postoperative care, were equivalent between children. Main Outcome Measures Occurrence of postoperative hemorrhage based on 3 severity stratification levels. Results Ninety-four of the 2788 children experienced 104 episodes of postoperative hemorrhage. After adjusting for age, sex, primary diagnosis, and surgical technique, the odds ratio of experiencing a postoperative hemorrhage of any severity in children who received the 1.0-mg/kg compared with the 0.5-mg/kg dose was 0.66 (95% confidence interval [CI], 0.42-1.05). Children requiring readmission with or without the need for operative intervention demonstrated an adjusted odds ratio of 0.83 (95% CI, 0.51-1.36). An adjusted odds ratio of 0.71 (95% CI, 0.39-1.28) was seen in children requiring operative intervention. Conclusion In this observational review of children undergoing tonsillectomy or adenotonsillectomy, perioperative dexamethasone administration is not associated with a dose-dependent elevation of postoperative hemorrhage rates after adjusting for age, sex, primary diagnosis, and surgical technique.
More from Archives of Otolaryngology Head & Neck Surgery Long-term Health-Related Quality of Life in Survivors of Head and Neck Cancer [Original Article] Archives of Otolaryngology Head & Neck Surgery: January 16, 2012, 12:00 pm Objective To examine health-related quality of life (HRQOL) reported by 5-year head and neck cancer survivors and factors that predicted these long-term scores. Design Prospective, observational outcomes study. Setting Tertiary care institution. Patients A total Sequential Bilateral Cochlear Implantation in Children: Quality of Life [Original Article] Archives of Otolaryngology Head & Neck Surgery: January 16, 2012, 12:00 pm Objective To assess the effect of sequential bilateral cochlear implantation in children on their quality of life (QoL). Design Prospective cohort-control study. Setting Tertiary academic referral center. Patients Thirty children with prelingual deafness underwent sequential Disinfection of Flexible Fiberoptic Laryngoscopes After In Vitro Contamination With Staphylococcus aureus and Candida albicans [Original Article] Archives of Otolaryngology Head & Neck Surgery: January 16, 2012, 12:00 pm Objective To determine the efficacy of various cleaning and disinfective methods in reducing bacterial and fungal load on flexible fiberoptic laryngoscopes (FFLs). Design In vitro model. Subjects Flexible fiberoptic laryngoscopes contaminated with Staphylococcus aureus Winter scene, Pittsburgh, Pennsylvania [About the Cover] Archives of Otolaryngology Head & Neck Surgery: January 1, 2012, 12:00 pm About This Journal [About This Journal] Archives of Otolaryngology Head & Neck Surgery: January 1, 2012, 12:00 pm
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