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Overnight Admissions After Younger Pediatric Tonsillectomy

In 1996, the American Academy of Pediatrics and the American Academy of Otolaryngology—Head and Neck Surgery (AAOHNS) released guidelines indicating that children younger than 3 be admitted overnight for postoperative observation. Studies had shown that young patients were at greater risk for postoperative complications that required readmission and inpatient care. Newer surgical techniques for tonsillectomy have helped to decrease the incidence of primary hemorrhage and shorten recovery time. More recent studies looking at complications with tonsillectomy in the very young—in addition to institutional and personal experiences in the operative setting—have caused some clinicians to question the need for overnight admission in these patients. In our experience, many patients who were electively admitted overnight met all of the criteria to be discharged home within 6 hours of their surgery.  A New Retrospective Review of Tonsillectomy More data are needed to establish an evidence-based justification for challenging the longstanding guidelines from AAOHNS. In the March 19, 2012 Archives of Otolaryngology—Head & Neck Surgery, my colleagues and I had a study published in which we retrospectively examined the outcomes of tonsillectomy performed in children under the age of 3. We recorded the complications they experienced. Among the 86 patients whose medical records were reviewed, 80 (93.0%) did not experience any intraoperative or postoperative complications. Complications after tonsillectomies were generally mild and typically linked to dehydration. Our study’s overall complication rate was beneath the 10% ceiling that has been deemed acceptable for ambulatory procedures by some in the field. Results from another study have reinforced our findings. Key Contributors for Success in Young Children Several factors likely contributed to the low rate of...

Reducing Risks for Postoperative Sore Throat

Administering a magnesium lozenge 30 minutes before surgery appears to reduce the incidence and severity of immediate postoperative sore throat (POST), according to a small analysis of patients undergoing orthopedic surgery. The incidence rate for POST was 23% among those who received the lozenge, compared with 57% for controls, in the second hour after surgery. Abstract: Anesthesiology, July 12, 2012...
Newly Revised Guidelines for Strep

Newly Revised Guidelines for Strep

This week, the Infectious Diseases Society of America (IDSA) published newly revised guidelines for Group A streptococcal pharyngitis, or “strep,” in the journal of Clinical Infectious Diseases. About 15 million people see the doctor every year complaining of a sore throat – but fewer than a third have strep throat (20-30% of children and 5-15% of adults). Regardless, up to 70% unnecessarily receive antibiotics. The following are highlighted by the IDSA guideline panel: Most throat infections are not caused by Group A streptococcus but by viruses, and therefore don’t require antibiotics, according to new guidelines released by the Infectious Diseases Society of America (IDSA). For confirmed strep infections, penicillin or amoxicillin are the antibiotic of choice, except in those who are allergic. Children who suffer from strep throat and have recurrent throat infections should not have their tonsils surgically removed for that reason alone, except in very specific cases (such as a child who has obstructive breathing). Risks of surgery generally don’t outweigh transient benefit. Children and adults do not need to be tested for strep if they have a cough, runny nose, hoarseness and mouth sores, which are strong signs of a viral throat infection. Symptoms of strep include pain that comes on suddenly, swallowing hurts, and fever without cold symptoms. Strep should still be confirmed through testing before antibiotics are prescribed.  “The guidelines promote accurate diagnosis and treatment, particularly in avoiding the inappropriate use of antibiotics, which contributes to drug-resistant bacteria,” said lead author Stanford T. Shulman, MD, in a recent press release by the IDSA. A podcast featuring the lead author and the full guidelines are...
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