Kahairi Abdullah

Predicting safe tonsillectomy for ambulatory surgery

OBJECTIVES To assess the safety of tonsillectomy procedure in local setting. METHODS Retrospective review of 267 tonsillectomy patients in Tengku Ampuan Afzan Hospital, Malaysia from January 2006 to December 2007. RESULTS Only 2.6% had trauma, 1.1% had difficult intubation, 0.7% had anaesthetic complication and none developed bleeding intra-operatively. Post-operatively, both primary and secondary haemorrhage showed prevalence of 1.9% each, 1.1% patients had infection and 0.4% patients had inability of extubation while another 1.9% had other complications. Duration of post-operative hospital stay was only slightly increased with occurrence of intra-operative complications but not with post-operative complications. Significant increase in risk was observed for both primary haemorrhage (OR: 1.05, 95% CI 1.01-1.09 min, P=0.020) and respiratory complications (OR: 1.08, 95% CI 1.01-1.16 min, P=0.024) by 4.5% and 8.3%, respectively, with every 1-min increase in length of surgery. CONCLUSIONS The observed low prevalence of complications corresponded with large number of studies denoting safety of tonsillectomy. This may well be increased by appropriately reducing the length of surgery. Although predictors for complications were unable to be determined, it is not advisable for ambulatory tonsillectomy to be performed on OSA patients considering the respiratory complications observed in our setting.

Tracheal agenesis as a rare cause of difficult intubation in a newborn with respiratory distress: a case report

IntroductionTracheal agenesis is a very rare congenital airway anomaly. It may pose a great challenge to the first attending physician both in diagnosis and in establishing the airway during the first day of life.Case presentationWe report a newborn Malay baby boy with trachea agenesis (type III by Floyds classification) who presented with severe respiratory distress immediately after birth. Clinical diagnosis in this case was not straightforward, as it started with difficulty in intubation followed by an unsuccessful emergency tracheostomy in the neonatal intensive care unit. Urgent surgical neck exploration with endoscopic examination in the general operating theatre revealed the final diagnosis. The authors present a short description of the embryopathology and diagnostic criteria of the abnormality.ConclusionWe hope this case presentation will be valuable in increasing the awareness of physicians about this rare cause of tracheal obstruction or difficult intubation.

Association Between Severity of Obstructive Sleep Apnea and Number and Sites of Upper Airway Operations With Surgery Complications

Importance In patients with obstructive sleep apnea (OSA), operative risks depend on the severity of the underlying OSA and the invasiveness of the surgical procedure. Objective To investigate the nature of the associations between the severity of OSA and the number and anatomical sites of upper airway operations with operative complications. Design, Setting, and Participants This retrospective study included adult patients diagnosed with OSA (apnea-hypopnea index [AHI], >5) who underwent upper airway surgery at a single tertiary referral hospital between October 1, 2008, and October 1, 2015. Interventions All patients underwent single or combination surgery on the nose, palatopharyngeal (tonsils, adenoids, and soft palate), and tongue base as a treatment of OSA. Main Outcomes and Measures Pulmonary, surgical, and cardiovascular complications within the first 30 postoperative days were analyzed according to OSA severity and types of upper airway surgery. Logistic regression was used to assess the multivariable association of OSA, age, sex, body mass index, medical comorbidities, and types of upper airway surgery with short-term operative complications. Results The study included 95 patients (87 males [91.6%]; 83 were Malay [87.4%]; mean [SD] age, 37.7 [1.6] years) with complete data and follow-up who underwent upper airway surgery to treat OSA. Patients with more severe OSA had greater body mass index (Cohen d, 0.27; 95% CI, −0.28 to 0.82), longer surgical time (Cohen d, 1.57; 95% CI, 0.95-2.15), and older age (Cohen d, 3.06; 95% CI, 2.29-3.77). At least 1 operative complication occurred in 48 of 95 patients (51%). In a multivariable model, the overall complication rate was increased with age and body mass index. Complication rates were not associated with AHI severity, type of procedure performed, and whether the surgery was single or combination surgery. Lowest oxygen desaturation (odds ratio, 1.03; 95% CI, 0.96-1.45; P = .04) and longest apnea duration (odds ratio, 1.03; 95% CI, 0.99-1.08; P = .02) were polysomnographic variables that predict the short-term operative complications. Conclusions and Relevance In patients with OSA undergoing upper airway surgery, the severity of OSA as assessed by AHI, and the sites and numbers of concurrent operations performed were not associated with the rate of short-term operative complications.

08:28: Traumatic Facial Nerve Palsy: The Outcome of Surgery

are not limited to the centra METHODS: Some 32 patients were randomized in order to obtain either temporal rTMS (10 sessions, 1Hz, left auditory cortex, 2000 pulses/d, 110% motor threshold) or a combination of temporal and prefrontal rTMS (10 sessions, at each session 20 Hz rTMS, left dorsolateral prefrontal cortex, 1,000 pulses/d, 110% motor threshold; followed by 1Hz, left auditory cortex, 1,000 pulses/d, 110% motor threshold). Tinnitus Severity was assessed before and after treatment and after a follow-up period of three months by using a standardized tinnitus questionnaire (TQ). RESULTS: Assessment of TQ score directly after therapy showed an improvement of the score for both groups but no differences between the two groups. Evaluation after three months revealed a remarkable advantage for the group of patients who received combined prefrontal and temporal rTMS. CONCLUSIONS: These results support recent data suggesting that auditory and nonauditory brain areas are involved in tinnitus pathophysiology. This should be considered in the development of future treatment strategies.