Süay Özmen

Pediatric tracheotomies: A 37-year experience in 282 children

OBJECTIVE To study the outcomes, complications, and indications for pediatric tracheotomies performed at a tertiary referral center. METHODS A retrospective review of hospital records from 1968 to 2005 was conducted to assess all pediatric patients who had undergone tracheotomies. RESULTS A total of 282 tracheotomies were performed on patients under 16 years of age. The median age at tracheotomy was 27 months. Upper airway obstruction (infectious diseases, n=101; laryngeal anomalies, n=33; trauma, n=36; tumor, n=33) was the most common indication for tracheotomy (n=203; 72%). Lesser number of patients (n=79; 28%) required tracheotomy for prolonged ventilation. Decannulation was carried out successfully in 71 patients (35%). Total complication rate was 18%; only three patients (1%) died from tracheotomy-related complications, with an overall mortality rate of 19%. CONCLUSIONS Pediatric tracheotomies were associated with a low incidence of procedure-related mortality and morbidity and successful decannulation in 35% of cases. The majority of procedures were performed due to upper airway obstruction which were most commonly caused by infectious diseases.

Topical bupivacaine compared to lidocaine with epinephrine for post-tonsillectomy pain relief in children: A randomized controlled study

OBJECTIVE To compare the topical administration of bupivacaine hydrochloride, lidocaine hydrochloride with epinephrine and saline in alleviating post tonsillectomy pain. STUDY DESIGN A double-blind prospective randomized controlled clinical study. METHODS Between November 2008 and March 2009, 60 patients (32 males and 28 females) between ages of 1.5 and 15 years were recruited into the study. After informed consent was obtained from the parents, patients, admitted for tonsillectomy, were randomized into three groups using sealed envelops. Group 1 (20 patients, mean age 5.2±1.7) received topical lidocaine hydrochloride (20 mg/ml) with 0.00125% epinephrine. Group 2 (20 patients, mean age 6±3.7) received topical 0.5% bupivacaine hydrochloride and group 3 (20 patients, mean age 6.7±3.6) received topical saline. RESULTS The post-operative pain scores at 1h were similar among the groups (p=0.29). Pain scores in bupivacaine hydrochloride group were significantly lesser than the saline group at 5th, 13th, 17th and 21st hours, until the sixth day (p<0.017). Moreover, pain scores of bupivacaine hydrochloride group were superior to lidocaine hydrochloride group starting at 17 h, until fourth day (p<0.017). Pain scores of lidocaine hydrochloride group were lesser than saline group in the first and fifth days (p<0.017), whereas, there was no significant difference at other times. CONCLUSION Topical administration of bupivacaine hydrochloride proved to provide more efficient pain control than both saline and lidocaine without any drug related complication.

Is local ointment or cauterization more effective in childhood recurrent epistaxis

OBJECTIVES To compare the efficacy of nasal antiseptic ointment and silver nitrate cautery in the treatment of children with recurrent epistaxis. METHODS In this prospective and randomized study, a hundred children with recurrent epistaxis were assigned into two groups. In group 1, patients underwent silver nitrate cauterization, in group 2 patients were treated with nasal antiseptic ointment (oxytetracycline hydrochloride-polymyxin B sulfate); and both groups were followed for 3 months. All of the patients were investigated for allergy with skin prick test. RESULTS The ages of patients were similar in both groups (group 1: 9.2±2.7; group 2: 8.2±2.2; p=0.069). Thirty-eight percent of the patients in group 1 and 52% of the patients in group 2 had epistaxis in the three months follow-up. The difference between groups was not significant (p=0.159). Thirteen (26%) of the patients in group 1 and 12 (24%) of the patients in group 2 were found to have allergic symptoms and positive prick test. The rate of allergy was similar in both groups (p=0.817). CONCLUSION Nasal antiseptic ointment and silver nitrate cauterization were found to have similar outcomes in the treatment of recurrent epistaxis.

Effects of levobupivacaine versus bupivacaine infiltration on postoperative analgesia in pediatric tonsillectomy patients: a randomized, double-blind, placebo-controlled study.

Objectives: We compared the effects of levobupivacaine hydrochloride, bupivacaine hydrochloride, and saline injections in alleviating posttonsillectomy pain. Methods: Between November 2009 and April 2010, we recruited 60 patients (36 male and 24 female) between 2 and 12 years of age into the study. After informed consent was obtained from the parents, patients admitted for tonsillectomy were randomized into 3 groups by means of sealed envelopes. Group 1 (20 patients; mean age, 6.45 ± 2.78 years) received 0.9% sodium chloride (saline solution), group 2 (20 patients; mean age, 5.60 ± 2.70 years) received 0.25% levobupivacaine hydrochloride, and group 3 (20 patients; mean age, 5.85 ± 2.43 years) received 0.5% bupivacaine hydrochloride infiltrated around each tonsil. Pain was evaluated with McGraths face scale. Results: The postoperative pain scores at 1 and 5 hours were similar among the groups (p > 0.05). The pain scores in the levobupivacaine group were lower than those in the saline group at 13 hours (p < 0.017). The pain scores in the bupivacaine and levobupivacaine groups were significantly lower than those in the saline group from 17 to 21 hours until day 6 (p > 0.017). There was no difference between the levobupivacaine and bupivacaine groups (p > 0.017). Conclusions: Local infiltration of levobupivacaine is a relatively safe and effective method and is equivalent to use of bupivacaine for posttonsillectomy pain.

Can We Improve Pressure Feedback Methods in Vestibular Evoked Myogenic Potentials by Applying Custom Pressures

OBJECTIVE The aim of the present study was to use constant and customized pressure levels to improve the feedback method of the blood pressure cuff technique in order to decrease intra-subject and inter-subject variability. MATERIALS AND METHODS The study was conducted in two stages. In the first stage, the relationship between the pressure level generated in the blood pressure cuff and electromyographic response in the sternocleidomastoid (SCM) muscle was investigated. In the second stage, vestibular evoked myogenic potential (VEMP) measurements were made using a custom-built VEMP chair at a constant pressure level of 40 mmHg (P40) or at 50% of the maximum pressure (Pmax50%) that could be generated by the SCM muscle. RESULTS VEMP measurements were performed on 100 volunteers consisting of 48 males and 52 females whose ages were between 20 and 68 years. The response rate was 41% on a subject basis and 53% on an ear basis. Response rates were similar in males and females, and they decreased with age. The response rate was significantly lower in 11% of the volunteers who could not generate the stipulated 80 mmHg pressure level. Response rates obtained with P40 and Pmax50% were similar, and p13 and n23 latencies and p13-n23 amplitudes obtained from both sides were also similar. Amplitudes were higher in Pmax50% measurements compared to P40, and amplitudes obtained with P40 levels showed greater variance compared to Pmax50%. CONCLUSION The use of Pmax50% provided reduced variation compared to P40; however, it did not have significant clinical implications. Further studies are needed for the control of many factors that are related to amplitude variability.