International journal of pediatric otorhinolaryngology
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Int. J. Pediatr. Otorhinolaryngol. · Nov 2014
ReviewConfronting the challenges of effective pain management in children following tonsillectomy.
Tonsillectomy is an extremely common surgical procedure associated with significant morbidity and mortality. The post-operative challenges include: respiratory complications, post-tonsillectomy hemorrhage, nausea, vomiting and significant pain. ⋯ This introduces a number of other safety concerns when deciding on a safe alternative to codeine, especially since most tonsillectomy patients are managed by lay primary caregiver's at home. This review outlines the safety issues and proposes, based on currently available evidence, a preventative multi-modal strategy to manage pain, nausea and vomiting without increasing the risk of post-tonsillectomy bleeding.
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Int. J. Pediatr. Otorhinolaryngol. · Oct 2014
Meta AnalysisKetamine peritonsillar infiltration during tonsillectomy in pediatric patients: An updated meta-analysis.
Peri-operative ketamine peritonsillar infiltration in children can reduce the incidence of postoperative nausea and vomiting (PONV), but its postoperative analgesic time is short. A previous meta-analysis in 2011 was inconclusive due to insufficient data. Consequently, we updated the meta-analysis to verify the role of ketamine peritonsillar infiltration for tonsillectomy in pediatric patients. ⋯ Compared to placebo, ketamine peritonsillar infiltration can relieve postoperative pain within one hour but not at 120 min and reduces analgesic requirement and incidence of PONV. Moreover, there was no difference in the first analgesic time.
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Int. J. Pediatr. Otorhinolaryngol. · Oct 2014
Review Case ReportsIatrogenic phenol injury: a case report and review of medication safety and labeling practices with flexible laryngoscopy.
Medication errors can be reduced by following standards in patient identification and medication labeling. We present an investigation of a life-threatening event from medication error: A newborn that received intranasal phenol instead of topical anesthetic prior to flexible laryngoscopy. ⋯ The hospital course was prolonged and included intensive care, delayed oral feeding with enteral support, and the need for several endoscopies. Current standards of medication labeling are reviewed as well as evidence for and against using topical agents for flexible laryngoscopy.
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Int. J. Pediatr. Otorhinolaryngol. · Oct 2014
Acetaminophen plus ibuprofen versus opioids for treatment of post-tonsillectomy pain in children.
To determine the efficacy and safety of acetaminophen plus ibuprofen in treatment of post-tonsillectomy pain compared to acetaminophen plus opioids in children. ⋯ Prescription of ibuprofen did not increase the risk of bleeding and did not increase the likelihood of a post-operative ED visit or nurse phone call. Ibuprofen prescription may possibly increase the risk of multiple bleeding episodes, but further prospective studies are needed. Increased age increases the risk of bleeding, ED visits, and nurse phone calls.
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Int. J. Pediatr. Otorhinolaryngol. · Sep 2014
Remote evaluation of video-otoscopy recordings in an unselected pediatric population with an otitis media scale.
A recently validated image-based grading scale for acute otitis media (OMGRADE) can be used to assess tympanic membrane (TM) status. The aim of this study was to evaluate the validity and reliability of this scale for remote assessments of TM status using video-otoscopy recordings in an unselected pediatric population. ⋯ The OMGRADE scale can be used to accurately assess the normal TM and secretory otitis media (SOM) remotely using video-otoscopy recordings in an unselected pediatric population.