The Laryngoscope
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Review Meta Analysis
Perioperative ketorolac increases post-tonsillectomy hemorrhage in adults but not children.
To evaluate the risk of post-tonsillectomy hemorrhage associated with perioperative ketorolac use. ⋯ Ketorolac can be used safely in children, but is associated with a five-fold increased bleeding risk in adults.
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Review Meta Analysis
Dexamethasone and postoperative bleeding after tonsillectomy and adenotonsillectomy in children: A meta-analysis of prospective studies.
Tonsillectomy and adenotonsillectomy are common pediatric surgical procedures. Although perioperative administration of dexamethasone is common, recent data indicate a possible association between dexamethasone and increased risk of postoperative hemorrhage. ⋯ There was no overall association between dexamethasone administration and postoperative bleeding in children undergoing tonsillectomy or adenotonsillectomy. However, this study cannot exclude the possibility of an association between specific dexamethasone doses and increased odds of bleeding. The results underscore the need for more dedicated prospective studies of this very common intervention.
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Review Meta Analysis Comparative Study
Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: a meta-analysis.
To compare by meta-analysis the effect of recurrent laryngeal nerve (RLN) monitoring versus RLN identification alone on true vocal fold palsy rates after thyroidectomy. ⋯ This meta-analysis demonstrates no statistically significant difference in the rate of true vocal fold palsy after using intraoperative neuromonitoring versus recurrent laryngeal nerve identification alone during thyroidectomy.
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The study aims to reconcile conflicting published reports regarding the clinical efficacy of a single intraoperative dose of dexamethasone in reducing post-tonsillectomy morbidity. ⋯ Given the frequency of tonsillectomy, relative safety and low cost of dexamethasone, and the reduction in postoperative morbidity, we recommend routine use of a single intravenous dose during pediatric tonsillectomy.
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Currently there is no agreement on the treatment of patients who develop a peritonsillar abscess (PTA). This lack of consensus results in highly variable and possibly expensive therapeutic regimens that may not provide optimum quality patient care at reasonable cost. The present study evaluates surgical, medical, diagnostic, and cost factors that affect the management of PTA based on the following: 1. a cohort study of 123 patients with PTA treated using needle aspiration as the initial surgical drainage; 2. a national survey of the PTA management practices of otolaryngologists; and 3. meta-analyses of various components of the treatment regimen for PTA. ⋯ Patients should be treated in an outpatient setting, should receive penicillin if they are not allergic to it, and should receive adequate pain medication. The evidence does not suggest that there is any benefit in examining the abscess contents for microorganisms. Approximately 30% of patients with PTA can be expected to exhibit relative indications for a tonsillectomy.(ABSTRACT TRUNCATED AT 400 WORDS)