The starship children's hospital tonsillectomy: A further 10 years of experience

Mahadevan, Murali; Meer, Graeme van der; Gruber, Maayan; Reed, Peter; Jackson, Conor; Brown, Colin R.; Mills, Nikki; Salkeld, Lesley; Neeff, Michel; Evans, Jan; Anderson, Brian J.; Barber, Colin

doi:10.1002/lary.26041

Cited by 24 publications

(32 citation statements)

References 20 publications

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“…Postoperative nausea and vomiting may necessitate alternative routes of administration in the perioperative period, with a transition to oral dosing as appropriate. The incidence of postoperative bleeding was 4.4%, consistent with a reported incidence of 4.3% (CI: 3.8%‐5.0%) . There is no evidence to support an increase in the incidence of postoperative bleeding in children following tonsillectomy by NSAIDs .…”

Section: Discussionsupporting

confidence: 73%

Analgesic effectiveness, pharmacokinetics, and safety of a paracetamol/ibuprofen fixed‐dose combination in children undergoing adenotonsillectomy: A randomized, single‐blind, parallel group trial

Playne

Anderson

Frampton

et al. 2018

Pediatric Anesthesia

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Summary Background Pain following tonsillectomy is often poorly managed in the home setting. Multimodal analgesia with acetaminophen (paracetamol) and nonsteroidal anti‐inflammatory drugs offers superior analgesia over monotherapy but may be difficult for caregivers to manage. A fixed‐dose combination oral suspension product containing paracetamol and ibuprofen has been developed to facilitate pediatric dosing. Aims The aims of this study are to determine the analgesic effectiveness, pharmacokinetics, and safety of the fixed‐dose combination at two doses in the pediatric population. Methods In this prospective, multicenter, randomized, single‐blind, parallel group trial, 251 children aged 2‐12 years undergoing day‐stay (adeno)tonsillectomy were randomized to two dose groups of the fixed‐dose combination. A doubled loading dose was given preoperatively, followed by treatment for up to 11 days (Higher dose: paracetamol 15 mg/kg + ibuprofen 4.5 mg/kg, Lower dose: paracetamol 12 mg/kg + ibuprofen 3.6 mg/kg). Blood samples were collected for pharmacokinetic analysis for up to 6 hours after the loading dose. The analgesic effectiveness was examined on the first day after surgery using both Parents Postoperative Pain Measurement and modified Wong‐Baker Faces pain scales. Rescue medication consumption was recorded throughout the study. Results Differences in maximum plasma concentration (Cmax) and total exposure (AUC0→t) between the treatment groups for both analytes were consistent with a 25% increase in dose; there was no difference in time to peak concentration (Tmax). On the first postoperative day, there was no difference in pain scores or rescue medication use between treatment groups (approximately 30% in both groups). The combination was well tolerated by both groups. The most common adverse events were vomiting and nausea. The incidence of postoperative bleeding was 4.4%. Conclusion The shallow dose‐response relationship and good tolerability of the fixed‐dose combination over an extended study period supports the utility of both doses of the fixed‐dose combination in the home setting.

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Section: Discussionsupporting

confidence: 73%

Analgesic effectiveness, pharmacokinetics, and safety of a paracetamol/ibuprofen fixed‐dose combination in children undergoing adenotonsillectomy: A randomized, single‐blind, parallel group trial

Playne

Anderson

Frampton

et al. 2018

Pediatric Anesthesia

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“…[3][4][5]10 During the study period, the University Hospital Geelong's practice was to keep all tonsillectomy patients overnight to ensure potential complications were managed. Individual institutional guidelines have not been based on evidence.…”

Section: Synopsis Of Key Resultsmentioning

confidence: 99%

“…2 The safety of day-case tonsillectomy has been well documented in the literature. [3][4][5] However, there are a number of serious complications which may make an overnight stay safer, including severe post-tonsillectomy haemorrhage and airway compromise. Airway complications including desaturation and stridor have been estimated to occur in up to 11.2 per cent of cases; some of these patients may even require re-intubation.…”

Section: Introductionmentioning

confidence: 99%

“…However, there are no evidence-based guidelines recommending which patients are safe for day-case tonsillectomy. [2][3][4][5][6] This study primarily aimed to determine which patients required significant intervention during the first 24 hours following tonsillectomy or adenotonsillectomy performed at a single institution over a 16-year period. The study also aimed to determine how the findings may apply to future evidence-based guidelines for safe patient selection for day-case tonsillectomy.…”

Section: Introductionmentioning

confidence: 99%

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Overnight in-hospital observation following tonsillectomy: retrospective study of post-operative intervention

2017

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Objective: The safety of day-case tonsillectomy is widely documented in the literature; however, there are no evidence-based guidelines recommending patient characteristics that are incompatible with day-case tonsillectomy. This study aimed to identify which patients should be considered unsafe for day-case tonsillectomy based on the likelihood of needing critical intervention.Method: Retrospective review of 2863 tonsillectomy procedures performed at University Hospital Geelong from 1998 to 2014.Results: Of the patients, 7.81 per cent suffered a post-tonsillectomy complication and 4.15 per cent required intervention. The most serious complications, haemorrhage requiring a return to the operating theatre and airway compromise, occurred in 0.56 per cent and 0.11 per cent of patients respectively. The following patient characteristics were significantly associated with poorer outcomes: age of two years or less ( p < 0.01), tonsillectomy indicated for neoplasm ( p < 0.01) and quinsy ( p < 0.05).Conclusion: The authors believe that all elective tonsillectomy patients should be considered for day-case surgery, with the following criteria necessitating overnight observation: age of two years or less; an indication for tonsillectomy of neoplasm or quinsy; and an American Society of Anesthesia score of more than 2.

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“…Both drugs display analgesic and antipyretic effects, and do so via distinct mechanisms of actions . They can be safely combined without increases in their associated adverse effect profiles and combination therapy is used for analgesia after tonsillectomy in children . A maximal analgesic effect ( E MAX ) of approximately 5/10 using a visual analog scale (VAS 0‐10) has been reported for acetaminophen in children after tonsillectomy and for dental pain relief in adults given ibuprofen; however an EC 50 for ibuprofen (effective concentration for 50% maximal effect) has yet to be reported in children.…”

Section: Introductionmentioning

confidence: 99%

Acetaminophen, ibuprofen, and tramadol analgesic interactions after adenotonsillectomy

Hannam

Anderson

Potts

2018

Pediatric Anesthesia

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The starship children's hospital tonsillectomy: A further 10 years of experience

Abstract: 4. Laryngoscope, 126:E416-E420, 2016.

Cited by 24 publications

References 20 publications

Analgesic effectiveness, pharmacokinetics, and safety of a paracetamol/ibuprofen fixed‐dose combination in children undergoing adenotonsillectomy: A randomized, single‐blind, parallel group trial

Analgesic effectiveness, pharmacokinetics, and safety of a paracetamol/ibuprofen fixed‐dose combination in children undergoing adenotonsillectomy: A randomized, single‐blind, parallel group trial

Overnight in-hospital observation following tonsillectomy: retrospective study of post-operative intervention

Acetaminophen, ibuprofen, and tramadol analgesic interactions after adenotonsillectomy

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