Adherence to Swedish guidelines for pain treatment in relation to pediatric tonsil surgery: A survey of the multidisciplinary team

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): F. Alm, M. Jaensson, S. Lundeberg, E. Ericsson
BackgroundPain management in children after tonsil surgery is essential, and optimal pain treatment has been discussed for many years. Data from the National Tonsil Register in Sweden (NTRS) and a national mapping have demonstrated the need for national pain treatment guidelines for pediatric tonsil surgery. As a result, Swedish national guidelines, together with updated patient information on the website tonsilloperation.se, were developed and implemented in 2013.ObjectivesThe objective of this study was to evaluate the professionals' opinions of and adherence to pain treatment guidelines for pediatric tonsil surgery patients in a two-year follow-up.MethodThis descriptive cross-sectional study was based on data from an inter-professional questionnaire, which was validated by an expert group using a content validity index (S-CVI 0.93). The questionnaire was sent to all Swedish ear, nose and throat (ENT) departments (n = 49) that the NTRS identified as performing tonsil surgery on children younger than 18 years of age. In each clinic, we asked for responses from staff in each of the following professions: ENT physicians, anesthesia physicians, registered nurse anesthetists, and registered nurses in the ENT departments.ResultsRespondents from 48 ENT departments participated, and 139/163 (85%) completed questionnaires were returned. The guidelines were reported as being clear, ensuring patient safety and providing optimal pharmacological treatment. Treatment was given according to the guidelines: Half of the departments gave pre- or intraoperative treatment with clonidine, betamethasone and high-dose paracetamol (acetaminophen). A multimodal pain approach (paracetamol and COX-inhibitors) after hospital discharge was prescribed by all departments after tonsillectomy and, extensively, after tonsillotomy. One-third of the departments prescribed paracetamol with a higher normal dose for the first three postoperative days. Half of the departments prescribed rescue analgesics, clonidine or opioids after tonsillectomy. None of the departments prescribed codeine or tramadol, drugs that are discouraged in the guidelines. The majority of the departments used the website tonsilloperation.se to provide information to the patients and their caregivers.ConclusionThe respondents' opinions of and the ENT departments adherence to the Swedish national guidelines were considered to be good. The national implementation process in Sweden has impacted the manner in which ENT departments treat pain after tonsil surgery.



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Thyroglossal duct cyst surgery: A ten-year single institution experience

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Justin Ross, Alexander Manteghi, Kimberly Rethy, James Ding, Sri Kiran Chennupati
Objective1. Review our institution's experience with thyroglossal duct cyst (TGDC) excision. 2. Determine if TGDC recurrence rate is influenced by surgical technique, preoperative infection, or surgeon specialty.MethodsWe conducted a retrospective analysis of patients at a tertiary care children's hospital who underwent excision of neck mass with proven TGDC histopathology from 2005 to 2015. Patient demographics and presentation, preoperative workup, surgeon specialty, procedural details, lesion characteristics, and complication rates including recurrence were evaluated.Results108 patients (51% male, 49% female), aged 6 months to 20 years (mean 6 years) met inclusion criteria. 121 procedures were performed: 96 (79.3%) for primary disease and 25 (20.7%) for recurrence. 32 patients (27.8%) were infected preoperatively, resulting in a significant increase in complications and recurrence (46.9% and 28.1%, respectively). Lack of preoperative imaging was correlated with increased recurrence (p = 0.0002). Recurrence rate after treatment for primary (11.3%) versus secondary disease (24%) was not significant (p = 0.23). Total recurrence rate differed between ENT (9.1%) and Pediatric Surgery (PS) (27.3%) (p = 0.0172). Difference was not significant for recurrence in primary disease (10% ENT, 14.8% PS, p = 0.49), but was for secondary disease (5.6% ENT, 71.4% PS, p = 0.002). Modifications of Sistrunk's procedure did not result in increased rates of recurrence (p = 0.1273).ConclusionPreoperative TGDC infection and lack of imaging led to a significant increase in postoperative complications, including recurrence. Surgical specialty significantly affected recurrence rates following excision overall and in secondary disease. Recurrence was not affected by surgical technique, age, sex, cyst size, or mucin rich histology.



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A review of oral cannabinoids and medical marijuana for the treatment of chemotherapy-induced nausea and vomiting: a focus on pharmacokinetic variability and pharmacodynamics

Abstract

Purpose

Oral cannabinoids (i.e., dronabinol, nabilone) containing the active component of marijuana, delta(Δ)9-tetrahydrocannabinol (THC), are available for the treatment of chemotherapy-induced nausea and vomiting (CINV) in patients with cancer who have failed to adequately respond to conventional antiemetic therapy. The aim of this article is to provide an overview of the efficacy, pharmacokinetics (PK), pharmacodynamics (PD), and safety of oral cannabinoids for patients with CINV.

Methods

A PubMed search of the English-language literature available through 4 January 2017 was conducted to identify relevant articles for inclusion in the review.

Results

Oral cannabinoids have been shown to have similar or improved efficacy compared with conventional antiemetics for the resolution of nausea and/or vomiting in patients with cancer. However, oral THC has high PK variability, with variability in oral dronabinol peak plasma concentrations (C _max) estimated between 150 and 200%. A new oral dronabinol solution has decreased intraindividual variability (area under the curve) vs oral dronabinol capsules. Further, oral THC has a slower time to C _max compared with THC administered intravenously (IV) or by smoking, and a lower systemic availability than IV or smoked THC. The PD profile (e.g., "high") of oral THC differs from that of IV or smoked THC in healthy individuals. Oral cannabinoids are associated with greater incidence of adverse effects compared with conventional antiemetic therapy or placebo (e.g., dizziness, hypotension, and dysphoria or depression).

Conclusions

A new formulation of oral cannabinoids (i.e., dronabinol oral solution) minimized the PK/PD variability currently observed with capsule formulations.

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Erratum to: Lipofilling effects after breast cancer surgery in post-radiation patients: an analysis of results and algorithm proposal

http://ift.tt/2vBAhGe

Response to ‘Eruptive keratoacanthomas arising in the setting of lichenoid toxicity after PD1 inhibition with nivolumab’

Abstract

We thank Dr. Fung and colleagues for their interest in our publication concerning eruptive keratoacanthomas (KAs) and bullous pemphigoid-like disease in patients on anti-programmed cell death-1 (PD-1) immunotherapy.¹ We agree that nivolumab, like pembrolizumab, seems to share the same immune-related adverse event profile, and in fact our second case occurred in a patient on nivolumab (after no visible reduction in metastatic disease on pembrolizumab).

This article is protected by copyright. All rights reserved.

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Evolution of the anterolateral thigh free flap.

Purpose of review: To review the recent literature on the evolution and advanced uses of the anterolateral thigh (ALT) free flap in reconstruction of oncologic defects of the head and neck. Recent findings: The ALT free flap is a versatile flap that can be harvested in a chimeric fashion with independent, vascularized skin, muscle, fascia, nerve and bone. Various techniques for chimeric flap harvest and flap inset have been described for reconstruction of pharyngocutaneous, oromandibular and radical parotidectomy defects. These reports expand the indications for the ALT free flap while demonstrating good functional and aesthetic outcomes. Summary: The ALT free flap remains popular for reconstruction of head and neck oncologic defects because of its versatility. Continued evolution in chimeric flap harvest techniques for pharyngocutaneous, osseous and radical parotidectomy defects highlights novel advanced reconstructive uses for the ALT free flap. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2ud9CiN

Evolution of the anterolateral thigh free flap.

Purpose of review: To review the recent literature on the evolution and advanced uses of the anterolateral thigh (ALT) free flap in reconstruction of oncologic defects of the head and neck. Recent findings: The ALT free flap is a versatile flap that can be harvested in a chimeric fashion with independent, vascularized skin, muscle, fascia, nerve and bone. Various techniques for chimeric flap harvest and flap inset have been described for reconstruction of pharyngocutaneous, oromandibular and radical parotidectomy defects. These reports expand the indications for the ALT free flap while demonstrating good functional and aesthetic outcomes. Summary: The ALT free flap remains popular for reconstruction of head and neck oncologic defects because of its versatility. Continued evolution in chimeric flap harvest techniques for pharyngocutaneous, osseous and radical parotidectomy defects highlights novel advanced reconstructive uses for the ALT free flap. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2ud9CiN