Shivani Shah-Becker

Early neurocognitive improvements following parathyroidectomy for primary hyperparathyroidism

To establish a time frame for postoperative improvements in neurocognitive function in patients who undergo parathyroidectomy for primary hyperparathyroidism by utilizing repeat neuropsychological assessment at multiple time points before and after surgery.

Baroreceptor reflex failure: Review of the literature and the potential impact on patients with head and neck cancer

Baroreceptor dysfunction and reflex failure may occur after surgery affecting the carotid artery. The implications for patients undergoing treatment for head and neck cancer are not well described.

Randomized Prospective Evaluation of Intraoperative Intravenous Acetaminophen in Pediatric Adenotonsillectomy

Objective To establish the safety and efficacy of single-dose intraoperative intravenous (IV) acetaminophen in postoperative pain management following adenotonsillectomy in addition to a standardized regimen of oral pain medication. Study Design Randomized, controlled prospective clinical trial. Setting Single academic medical center. Subjects and Methods Patients between the ages of 3 and 17 years scheduled for tonsillectomy or adenotonsillectomy by a single surgeon between December 2014 and November 2016 were recruited. Patients were randomly assigned to 1 of 2 groups; group 1 received a single intraoperative dose of IV acetaminophen, and group 2 did not. Induction and maintenance of anesthesia, as well as operative technique, were standardized. Nursing pain scores, pain medications administered, and recovery times were reviewed during the 24-hour postoperative period. Postoperative pain regimen included standing alternating oral acetaminophen and ibuprofen. Results In total, 260 patients were included in the study, and 131 (50.4%) received a single intraoperative dose of IV acetaminophen. Patients receiving IV acetaminophen were more likely to experience postoperative nausea and vomiting than patients who did not receive IV acetaminophen (1.53% vs 0.00%, P = .016). There were no significant differences noted for postoperative pain scores, requirements for breakthrough pain medications, time to discharge from the recovery room or hospital, or postoperative complications. Conclusion The use of a single intraoperative dose of IV acetaminophen was associated with minimal additional adverse effects. However, a single intraoperative IV dose of acetaminophen added to standard narcotic and nonnarcotic pain medication does not provide a statistically significant improvement in pain control.

Current management and referral patterns of pediatricians for acute otitis media

OBJECTIVE The American Academy of Pediatrics (AAP) has published an evidence-based clinical practice guideline for the management of acute otitis media (AOM), most recently revised in 2013. This study aims to assess current practice patterns and how they compare to the published guideline. METHODS An 11 question survey addressing topics included in the 2013 AAP AOM guidelines was mailed to 196 practicing pediatricians. Statistical analysis was performed using Chi-square and ANOVA testing. RESULTS 76 (38%) completed surveys were returned. 75% of respondents were in group practice (non-academic) and 83% were in practice 11 years or more. 93% were members of the AAP. 46% of responding pediatricians use pneumatic otoscopy and/or tympanometry at least once a day to aid in the diagnosis of AOM, while 28% never do. 15% of respondents would choose close observation over antibiotics in a child under the age of 2 years with unilateral non-severe AOM while 50% would choose close observation in a child over age 2. 75% would make a referral to Otolaryngology for recurrent AOM. No significant differences were noted in responses based on practice type, years in practice, or Otolaryngology experience during residency training. CONCLUSIONS Current pediatrician practice and referral patterns for AOM are not consistent with 2013 Guidelines from the AAP. As consulting surgeons, Otolaryngologists should have knowledge of management protocols in related specialties that can have an impact on their practice.

Neck hematoma after major head and neck surgery: Risk factors, costs, and resource utilization

Postoperative cervical hematoma after major head and neck surgery is a feared complication. However, risk factors for developing this complication and attributable costs are not well‐established.

Transoral Robotic Surgery for Tonsillar Cancer

The introduction of robotic-assisted surgery in tonsillar cancer has allowed more advanced and extensive tumors to be treated with surgery. The transoral approach avoids the morbidity of an open procedure while still achieving complete oncologic resection, including margins. The magnified three-dimensional view along with the use of angled endoscopic cameras with 360° radius provides visualization beyond the tonsillar fossa to the great vessels laterally, the palate and nasopharynx superiorly, and the tongue base inferiorly, which could not be achieved using traditional transoral headlight or operative microscope alone.

Effect of single dose intraoperative IV acetaminophen in pediatric tonsillectomy or adenotonsillectomy

Abstract Background A number of different treatment regimens have been described for post-operative pain management for pediatric tonsillectomy following the widespread discontinuation of the use of codeine due to safety concerns. However, the literature is lacking with regard to the relative efficacy of the treatment regimens. This study is designed to determine the effectiveness of an intraoperative dose of intravenous acetaminophen for pediatric tonsillectomy pain management. Methods Records were reviewed for pediatric patients undergoing tonsillectomy with a single surgeon between 2012 and 2014. Pain scores, need for narcotic analgesics, and recovery times were reviewed for up to 24 postoperative hours. Patients were grouped based on whether they received an intraoperative dose of intravenous acetaminophen (Group 1) or did not receive it (Group 2). The primary outcome measure was pain score during the 24-h post-operative period. Secondary outcome measures include need for narcotic medications for breakthrough pain in the recovery room and time spent in the recovery room and hospital. Results 350 patients were included, of which 116 received an intraoperative dose of intravenous acetaminophen. Patients in Group 1 had lower pain scores during the second postoperative hour (1.27 vs. 2.06, p = 0.008). No significant differences were noted for pain scores during postoperative hours 1 or 3–24. Patients in Group 1 spent less time in the Recovery Room (59.08 min vs. 69.5 min, p = 0.016) but more time in the hospital (24.54 h vs. 19.66 h, p = 0.030). There was no difference between the groups based on whether the patients received narcotics for breakthrough pain in the recovery room (79.3% vs. 70.9%, p = 0.094). Conclusion Intraoperative intravenous acetaminophen may lead to improved pain scores in the early postoperative period and decreased time in the recovery room, but this group also had a longer hospital stay. This information should instigate randomized controlled trials of this intervention.