2015 HSC Section 1 Book of Articles

Gallagher TQ, Hill C, Ojha S, et al. Perioperative dexamethasone administration and risk of bleeding following tonsillectomy in children: a randomized controlled trial. JAMA . 2012; 308(12):1221-1226. EBM level 1......................................................................74-79 Summary: This is a multicenter, prospective, randomized placebo-controlled trial of perioperative dexamethasone as a risk factor for postoperative bleeding following tonsillectomy. Using a noninferiority study design, perioperative dexamethasone was not associated with excessive clinically significant bleeding requiring hospital admission or reoperation, but increased mild, self-reported bleeding events could not be excluded.

Katz ES, Moore RH, Rosen CL, et al. Growth after adenotonsillectomy for obstructive sleep apnea: an RCT. Pediatrics . 2014; 134(2):282-289. EBM level 1....................80-87

Summary: This article describes secondary outcomes from a multicenter, randomized controlled trial of adenotonsillectomy in children for treatment of obstructive sleep apnea evaluating anthropometric changes. The adenotonsillectomy children demonstrated significantly greater weight increases in all weight categories at the 7-month follow up compared to the children in the watchful waiting group. This occurred in both overweight and non-overweight children, but overweight children were more likely to be obese at follow up.

Kheirandish-Gozal L, Bhattacharjee R, Bandla HP, Gozal D. Antiinflammatory therapy outcomes for mild OSA in children. Chest . 2014; 146(1):88-95. EBM level 4........88-95

Summary: This is a retrospective review of 836 children with mild obstructive sleep apnea treated with a combination of 12 weeks of an intranasal steroid and oral montelukast to determine polysomnography outcomes. A beneficial response was found in >80% of children. The authors recommend implementation of a multicenter randomized trial to further establish the role of anti-inflammatory therapy for children with mild OSA. Roland PS, Rosenfeld RM, Brooks LJ, et al. Clinical practice guideline: polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg . 2011; 145(1S):S1-S15. EBM level 1.......................96-110 S ummary: This is a clinical practice guideline produced for otolaryngologists by the American Academy of Otolaryngology–Head and Neck Surgery Foundation to provide evidence-based recommendations for using polysomnography to assess sleep-disordered breathing prior to tonsillectomy in children aged 2 to 18 years. Specific action statements were formulated regarding the indications for polysomnography, advocating for polysomnography, communication with the anesthesiologist, inpatient admission for children with obstructive sleep apnea, and the use of unattended polysomnography.