Future of pediatric tonsillectomy and perioperative outcomes

Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care

“…Codeine should be avoided, especially in children, because its CYP2D6 metabolism to the active drug (morphine) is inconsistent, sometimes causing it to be ineffective in poor metabolizers, and occasionally leading to morphine overdose and death in extensive metabolizers. 65,66 Patients with OSA should have continuous pulse oximetry monitoring with audible alarms for desaturation below 90% partial pressure of oxygen. Patients should preferably be within the line of sight of the nursing station.…”

Effectiveness of hyaluronic acid in post-tonsillectomy pain relief and wound healing: A prospective, double-blind, controlled clinical study

“…The healing of tonsillar fossa takes about 2 weeks and, although gradually decreasing over the first week, significant to moderate pain resides during that period (4). Post-tonsillectomy pain may lead to poor oral intake, dehydration, late hemorrhage, emesis, sleep disturbances and behavioral differences and, therefore, usually requires careful management by oral analgesics (2,(5)(6)(7)10,11,24,25). The mostly prescribed opioids for post-tonsillectomy pain relief are acetaminophen with codeine and oxycodon or hydrocodone (4,5).…”

“…Oral opioids such as codeine and nonsteroidal anti-inflammatory drugs are usually used to manage pain after tonsillectomy (2,7). It was well reported that respiratory depression, sedation and bleeding resulted from the unpredictable metabolism of opioids were one of the reasons of morphine toxicity causing morbidity and life-threading post-tonsillectomy complications (2,5,10).…”

“…It was well reported that respiratory depression, sedation and bleeding resulted from the unpredictable metabolism of opioids were one of the reasons of morphine toxicity causing morbidity and life-threading post-tonsillectomy complications (2,5,10). Therefore, the use of safer opioid and non-opioid analgesics as an alternative approach to relieve the pain caused by tonsillectomy is getting more important.…”

Non-fatal extensive cerebral venous thrombosis as a complication of adenotonsillectomy

“…Sleep disordered breathing, obstructive sleep apnea and recurrent throat infection are the most common indications, all of which can significantly impact a child's quality of life [1]. Despite its routine nature, throat pain, postoperative nausea and vomiting, delayed feeding and postoperative hemorrhage are some of the more commonly encountered adverse outcomes [2][3][4]. However, there are rare but serious and possibly life threatening complications that may arise.…”