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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.