Browsing by Subject "Tonsillectomy"
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Item The Outcomes of Tonsillectomy in Obese Pediatric Patients with Obstructive Sleep Apnea(2017-01-17) Wang, John E.; Mitchell, Ron B.; Johnson, Romaine F.INTRODUCTION: Pediatric obstructive sleep apnea (OSA) is characterized by obstruction of the upper airway during sleep leading to inadequate ventilation. OSA is a common disorder, occurring in 1-4% of young children that can cause attention problems, a reduced quality of life, increased sympathetic tone and cardiovascular abnormalities. The first line treatment for OSA in children is a tonsillectomy (with or without adenoidectomy or T&A.) However, the rate of resolution of OSA (tested by polysomnography [PSG]) after T&A is not as high as expected in obese children. The primary objective of this study is to compare the outcomes of T&A between normal-weight and overweight, and obese children. The secondary objective is to determine any potential predictors for improvement or resolution. METHODS: A cohort of 112 obese and 114 non-obese children aged 2-18 years who underwent PSG, a subsequent T&A for OSA, and a post-op PSG at Children's Medical Center UT Southwestern, Dallas was included. Demographics, clinical findings, and polysomnographic parameters (before and after T&A) were recorded. RESULTS: Obese patients had a higher AHI post-op than non-obese patients (7.6 and 3.7 respectively [p-value=.027]). Weight gain among obese patients positively predicted the residual AHI, indicating that the residual AHI increases as post-op weight gain increases (Coefficient 1.66; 95% CI 0.54 to 2.77; t=8.5, p=0.003; Y-intercept = 24.8+1.66X). Among obese patients, presence of asthma also predicts higher residual AHI, with asthma and obesity showing a multiplicative effect (p-value=.015). We also found that obese patients gained more weight (8.8 kg) than non-obese patients (4.9 kg) (p-value<.001). CONCLUSION: Our study reinforces previous findings that obese patients have a lower resolution of OSA than other children. Furthermore, we found that obese patients were also more likely to gain weight after T&A than overweight and normal-weight patients. In obese patients, those that gained more weight were more likely to have residual obstructive sleep apnea. This study brings up the question of weight management in the obese pediatric OSA patient with T&A. In addition, obese patients that also had asthma were also more likely to have residual OSA. It is possible that the nasal congestion and bronchoconstriction in asthma magnifies the effect of fat deposition on the airway.Item [Southwestern News](1993-11-24) Swendson, ShannaItem Use of Respiratory Acoustic Monitor for Postoperative Monitoring in Children(2016-01-19) Williams, Timothy; Aboul-Fettouh, Nader; Ploski, Roxana; Griffin, Allison; Szmuk, PeterRecording vital signs is the standard of care for all patients on the hospital wards after surgery to detect respiratory and cardiovascular depression before serious complications ensue. Of all the vital signs, an altered respiratory rate is one of the best predictors of respiratory depression, cardiac arrest, and admission to the ICU. Despite its clinical importance, respiration rate is the last core vital sign without a reliable and continuous monitoring method that patients can easily tolerate. Besides manually counting respiration, the two standards of care for monitoring respiratory rate: thoracic impedance pneumography (Tl) and capnometry, fall short of monitoring respiratory rate in a reliable and tolerable fashion. These limitations have lead the Masimo corporation to develop a bio-acoustic respiratory rate monitor (RAM) to non-invasively convert acoustical airflow patterns detected from the surface of the neck into respiratory rate measurements using an innovative adhesive sensor with an integrated acoustic transducer. The accuracy and reliability of RAM has not been evaluated in the in-patient surgical wards of the pediatric population. We compared the reliability and accuracy of RAM and Tl monitoring in postoperative pediatric patients at risk of adverse respiratory events while also assessing the tolerance of the RAM sensor and ECG pads (Tl). We recruited thirty children from 2 to 16 years old (mean age 6.58) who had a tonsillectomy due to OSA at Children's Medical Center (Dallas, TX). Following arrival to the inpatient care unit an adhesive RAM sensor and pediatric Sp02 finger sensor were connected along with standard Tl ECG pads. Vital signs were recorded from the RAM sensors and Tl, and a manual RR was obtained every 2-hours until patient discharge. Data from these 30 patients were combined with 30 patients recruited from Cincinnati Children's Hospital (Cincinnati, OH) for statistical analysis. The three measurement methods (Manual, RAM, and Tl) were found to be significantly different {p=0.0255). RAM and manual measurements of RR were on the average not significantly different (p=0.0255) with a higher correlation coefficient (0.5851), whereas Tl and manual RR measurements of RR are significantly different (p=0.0066) with a lower correlation coefficient (0.4898). The average RR difference between RAM and manual was 0.17 ± 6.81, and the average RR difference for Manual vs Tl was 1.39 ft 10.63. Additional results suggest that RAM may prove a more accurate and tolerable method for monitoring pediatric respiratory rate and respiratory depression, cardiac arrest, and admission to the ICU than the standard of care methods currently in use in hospitals across the country.