OBJECTIVE: Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by a perception and psychomotor disorder, with a negative impact on postoperative recovery. As the use of inhalation anesthesia is associated with a higher incidence of ED, we investigated whether titrating the depth of general anesthesia with BIS monitor can reduce the incidence of ED. DESIGN: Randomized, prospective, and double-blind. SETTING: Patients undergoing endoscopic adenoidectomy under general anesthesia according to a uniform protocol. PATIENTS: A total of 163 patients of both sexes aged 3-8 years were enrolled over 18 months. INTERVENTIONS: Immediately after the induction of general anesthesia, a bispectral index (BIS) electrode was placed on the patient's forehead. In the study group, the depth of general anesthesia was monitored with the aim of achieving BIS values of 40-60. In the control group, the dose of sevoflurane was determined by the anaesthesiologist based on MAC (minimum alveolar concentration) and the end-tidal concentration. MEASUREMENTS: The primary objective was to compare the occurrence of ED during the PACU (post-anesthesia care unit) stay in both arms of the study. The secondary objective was to determine the PAED score at 10 and 30 min in the PACU and the need for rescue treatment of ED. MAIN RESULTS: 86 children were randomized in the intervention group and 77 children in the control group. During the entire PACU stay, 23.3% (38/163) of patients developed ED with PAED score >10: 35.1% (27/77) in the control group and 12.8% (11/86) in the intervention group (p = 0.001). Lower PAED scores were also found in the intervention group at 10 (p < 0.001) and 30 (p < 0.001) minutes compared to the control group. The need for rescue treatment did not differ between groups (p = 0.067). CONCLUSION: Individualization of the depth of general anesthesia with BIS monitoring is an effective method of preventing ED in children. CLINICAL TRIAL REGISTRATION: NCT04466579.
- MeSH
- celková anestezie * škodlivé účinky MeSH
- dítě MeSH
- inhalační anestezie * škodlivé účinky MeSH
- lidé MeSH
- pooperační delirium * epidemiologie prevence a kontrola etiologie MeSH
- předškolní dítě MeSH
- probouzení z anestezie MeSH
- prospektivní studie MeSH
- sevofluran MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
BACKGROUND: Postoperative nausea and vomiting (PONV) is a significant problem following paediatric surgery, and volatile anaesthetics are an important cause of this phenomenon. BIS-guided anaesthesia, by reducing the consumption of anaesthetics, leads to a decrease in PONV in adult patients. STUDY OBJECTIVE: Evaluate the role of BIS-guided anaesthesia in reducing the incidence of paediatric PONV. DESIGN: Prospective, randomized, double-blind study. SETTING: A single center study in university hospital in Czech republic, from June 2021 to November 2022. PATIENTS: A total of 163 children, aged 3-8 years with ASA I-II who underwent endoscopic adenoidectomy under general anaesthesia were included. INTERVENTIONS: In the intervention group, the depth of anaesthesia was maintained to values between 40 and 60 of BIS. MAIN OUTCOME MEASURE: The primary outcome was the incidence of postoperative nausea and vomiting during 24 h after surgery. RESULTS: The use of BIS-guided anaesthesia led to a significant decrease in the incidence of nausea and vomiting compared to the control group [17% vs. 53%; RR (95%CI) 0.48 (0.27-0.86); p < 0.001and 16% vs. 34%; RR (95%CI) 0.33 (0.20-0.54); p = 0.01, respectively]. CONCLUSIONS: BIS-guided anaesthesia decreases the incidence of postoperative nausea and vomiting in children undergoing adenoidectomy. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04466579.
- MeSH
- adenektomie * škodlivé účinky metody MeSH
- celková anestezie * metody škodlivé účinky MeSH
- dítě MeSH
- dvojitá slepá metoda MeSH
- incidence MeSH
- lidé MeSH
- pooperační nevolnost a zvracení * epidemiologie prevence a kontrola MeSH
- předškolní dítě MeSH
- prospektivní studie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVES: Mulberry-like changes of the posterior inferior nasal turbinate (MPINT) can lead to nasal obstruction. Extraesophageal reflux (EER) characterized by lower pH causes mucosal inflammation and therefore can contribute to sinonasal pathologies. No prior studies have objectively examined the possible association between acidic pH and MPINT formation. Therefore, this study is aimed to investigate the 24-h pharyngeal pH value in patients with MPINT. STUDY DESIGN: Prospective case-control multi-center study. METHODS: Fifty-five patients with chronic EER symptoms were included in the study. They filled in questionnaires aimed at reflux and sinonasal symptoms (RSI®, SNOT-22) and underwent video endoscopy evaluating the laryngeal findings (RFS®) and the presence or absence of the MPINT. And, 24-h oropharyngeal pH monitoring was used to detect the acidic pH environment in the pharynx. RESULTS: Out of the 55 analyzed patients, 38 had the MPINT (group 1), and in 17 patients, the MPINT was absent (group 2). Based on the pathological RYAN Score, in 29 (52.7%) patients, severe acidic pH drops were detected. In group 1, the acidic pH drops were diagnosed significantly more often (68.4%) compared with those in group 2 (p = 0.001). Moreover, in group 1, a significantly higher median total percentage of time spent below pH 5.5 (p = 0.005), as well as a higher median number of events lasting more than 5 min (p = 0.006), and higher median total number of events with pH drops (p = 0.017) were observed. CONCLUSION: In this study, the MPINT was significantly more often present in patients with acidic pH events detected by 24-h oropharyngeal pH monitoring. Acidic pH in the pharynx might lead to MPINT formation. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:62-68, 2024.
- MeSH
- farynx MeSH
- gastroezofageální reflux * diagnóza MeSH
- koncentrace vodíkových iontů MeSH
- lidé MeSH
- Morus * MeSH
- nosní skořepy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- MeSH
- antihistaminika klasifikace terapeutické užití MeSH
- dítě MeSH
- kinetózy * klasifikace patofyziologie terapie MeSH
- lidé MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
Chondrosarcoma of the thyroid cartilage is a sporadic disease with nonspecific clinical presentation. Smooth swelling of the supraglottic area should arouse suspicion of possible pathology. In addition to laryngoceles, which usually do not have a significant impact, otolaryngologists should consider chondrosarcoma of the thyroid cartilage and indicate computed tomography (CT). Late diagnosis leads to worse prognosis, particularly worse voice after more extensive surgery, need for tracheostomy, and worse survival from higher degree chondrosarcomas.
- MeSH
- chondrosarkom * diagnostické zobrazování chirurgie MeSH
- laryngektomie metody MeSH
- laryngocele * chirurgie MeSH
- lidé MeSH
- nádory hrtanu * patologie MeSH
- tyreoidální chrupavka chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Postdischarge nausea and vomiting (PDNV) cause substantial pediatric morbidity with potentially serious postoperative complications. However, few studies have addressed PDNV prevention and treatment in pediatric patients. Here we searched the literature and processed it in a narrative review describing PDNV incidence, risk factors, and management in pediatric patients.. A successful strategy for reducing PDNV considers both the pharmacokinetics of the antiemetic agents and the principle of multimodal prophylaxis, utilizing agents of different pharmacologic classes. Since many highly effective antiemetic agents have relatively short half-lives, a different approach must be used to prevent PDNV. A combination of oral and intravenous medications with longer half-lives, such as palonosetron or aprepitant, can be used. In addition, we designed a prospective observational study with the primary objective of determining PDNV incidence. In our study group of 205 children, the overall PDNV incidence was 14.6% (30 of 205), including 21 children suffering from nausea and 9 suffering from vomiting.
- MeSH
- antiemetika * terapeutické užití MeSH
- dítě MeSH
- lidé MeSH
- následná péče MeSH
- pooperační nevolnost a zvracení prevence a kontrola farmakoterapie MeSH
- pozorovací studie jako téma MeSH
- propuštění pacienta MeSH
- prospektivní studie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
INTRODUCTION: The incidence of advanced oral cavity and oropharyngeal cancers is generally high. Treatment outcomes for patients, especially those unfit for comprehensive cancer treatment, are unsatisfactory. Therefore, the search for factors to predict response to treatment and increase overall survival is underway. OBJECTIVE: This study aimed to analyze the presence of 32 HPV genotypes in tumor samples of 34 patients and the effect of HPV status and RAD51 on overall survival. METHOD: Tumor samples of 34 patients with locally advanced oropharyngeal or oral cavity cancer treated with accelerated radiotherapy in monotherapy were analyzed using reverse hybridization and immunohistochemistry for the presence of HPV and RAD51. Its effect on overall survival was examined. RESULTS: Only two types of HPV were identified-HPV 16 (dominant) and HPV 66 (two samples). The HPV positivity was associated with a borderline insignificant improvement in 2-year (p = 0.083), 5-year (p = 0.159), and overall survival (p = 0.083). Similarly, the RAD51 overexpression was associated with borderline insignificant improvement in 2-year (p = 0.083) and 5-year (p = 0.159) survival. CONCLUSION: We found no statistically significant differences but detected trends toward improvement in the survival of HPV-positive and RAD51 overexpressing patients unfit for surgical treatment or chemotherapy treated with hyperfractionated radiotherapy. The trends, however, indicate that in a larger group of patients, the effects of these two parameters would likely be statistically significant.
- MeSH
- infekce papilomavirem * komplikace MeSH
- lidé MeSH
- nádory orofaryngu * MeSH
- prognóza MeSH
- rekombinasa Rad51 MeSH
- spinocelulární karcinom * patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Úvod a cíl: Mimojícnový reflux (EER) je zpětný tok žaludečních šťáv (nejčastěji kyselých) nad úroveň horního jícnového svěrače (tím se liší od gastroezofageálního refluxu). Příznaky mimojícnového refluxu jsou nespecifické, různé intenzity a závisí na lokalizaci patologického působení refluxátu. V případě působení refluxátu na zubní tkáň může EER přispívat ke vzniku zubních erozí. Vedle refluxátu jsou zvažovány i další faktory, jako je složení slin a mikrobiom ústní dutiny. V posledních letech došlo k významnému posunu v chápání mimojícnového refluxu, zejména patogeneze a z toho vyplývajících důsledků pro diagnostiku a léčbu. Cílem článku je informovat o EER a podat přehled o současných možnostech diagnostiky a jeho léčby a také shrnout výsledky nedávných metaanalýz týkajících se role EER při vzniku zubních erozí. Metodika: Podkladem pro článek byly odborné publikace získané v databázích PubMed, Cochrane Library a Scopus z let 2002–2022. Publikace se vyhledávaly pomocí kombinace klíčových slov v anglickém i českém jazyce: mimojícnový reflux, gastroezofageální reflux, zubní eroze. Celkem bylo analyzováno 21 studií pojednávajících o souvislosti mezi refluxem a zubními erozemi prostřednictvím přehledových, klinických prospektivních a retrospektivních studií a metaanalýz. Zahrnuté studie byly provedeny u dospělé populace a informace o gastroezofageálním refluxu ve vztahu ke vzniku zubních erozí byly využity jen za předpokladu jeho diagnostiky multikanálovým intraluminálním monitorováním pH impedance. V první části článku je prezentován současný pohled na patofyziologii, diagnostiku a léčbu EER. Druhá část shrnuje poznatky o dentálních erozích. Ve třetí části jsou prezentovány studie zabývající se vlivem EER na zubní eroze. Výsledky: Získané informace svědčí o vyšší prevalenci dentálních erozí u pacientů s EER v porovnání se zdravou populací. Důvodem je, že kyseliny jak exogenního, tak endogenního původu hrají důležitou roli v rozpouštění minerálů skloviny, což ve výsledku vede ke vzniku zubních erozí. Na základě analyzovaných studií nelze v současnosti považovat vztah mezi refluxem a vznikem zubních erozí za kauzální, a to zejména z důvodu nízké kvality studií. Autoři doporučují provádění dalších studií, ve kterých by byl vztah mezi EER a zubními erozemi dále zkoumán. Závěr: Na základě dosavadních poznatků lze předpokládat účast mimojícnového refluxu na rozvoji dentálních onemocnění. Možnou souvislost podporuje i fakt, že prevalence dentálních erozí v populaci s refluxem nebo prevalence refluxu v populaci s dentálními erozemi je ve srovnání se zdravou populací mnohem vyšší. V budoucnosti je potřeba dalších studií, které by zkoumaly kauzalitu mimojícnového refluxu při vzniku zubních erozí.
Introduction, aim: Extraesophageal reflux (EER) is the backflow of gastric fluids (most often acidic) above the level of the upper esophageal sphincter (it differs from gastroesophageal reflux). The symptoms of extraesophageal reflux are non-specific, of varying intensity and depend on the location of the pathological action of the refluxate. In the case of the effect of refluxate on the hard dental tissue, EER can contribute to the formation of dental erosions. In addition to refluxate, other factors such as the composition of saliva and the microbiome of the oral cavity are discussed. In recent years, there has been a significant shift in the understanding of extraesophageal reflux, especially the pathogenesis, and the resulting implications for diagnosis and treatment. The aim of the article is to inform about EER and give an overview of the current possibilities of diagnosis and its treatment, as well as to summarize the results of recent meta-analyses regarding the role of EER in the development of dental diseases. Methods: The basis for the presented article was professional publications obtained in the PubMed, Cochrane Library and Scopus databases from 2002 to 2022. Publications were searched using a combination of keywords in English and Czech languages: extraesophageal reflux, gastroesophageal reflux, dental erosion. A total of 21 studies discussing the association between reflux and dental erosions were analyzed through review, clinical prospective and retrospective studies and meta-analyses. The included studies were conducted in the adult population and information on gastroesophageal reflux in relation to the occurrence of dental erosions was used only if it was diagnosed by multichannel intraluminal pH impedance monitoring. The first part of the article presents a current view of the pathophysiology, diagnosis and treatment of EER. The second part summarizes knowledge about dental erosions. In the third part, studies dealing with the effect of EER on dental erosion are presented. Results: The obtained information indicates a higher prevalence of dental erosions in patients with EER compared to the healthy population. The reason is that acids of both exogenous and endogenous origins play an important role in dissolving enamel minerals, which ultimately leads to tooth erosion. Based on the analyzed studies, the relationship between reflux and the development of dental erosions cannot currently be considered causal, mainly due to the low quality of the studies. The authors recommend that further studies investigating the relationship between EER and dental damage should be conducted. Conclusions: Based on the findings, it can be assumed that extraesophageal reflux is involved in the development of dental diseases. A possible link is also supported by the fact that the prevalence of dental erosions in population with reflux or the prevalence of reflux in the population with dental erosions is much higher compared to the healthy population. In the future, however, further studies are needed to investigate the causality of extraesophageal reflux in the occurrence of dental erosions.
- MeSH
- eroze zubů * etiologie MeSH
- laryngofaryngeální reflux * komplikace MeSH
- lidé MeSH
- mikrobiota MeSH
- sliny MeSH
- ústa mikrobiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
In this study, we aimed to observe the effects of positive airway pressure (PAP) on individual levels of obstruction during drug-induced sleep endoscopy (DISE) of the upper airways (UA), to evaluate at which pressures the obstruction disappeared or worsened, and to identify cases in which PAP was ineffective. This prospective study was conducted from June 2018 to June 2022. PAP testing was performed during DISE in patients with moderate and severe OSA. The pressure was gradually increased over the range from 6.0 to 18.0 hPa. Our findings were evaluated using the VOTE classification. The examination was performed in 56 patients, with a median apnea-hypopnea index (AHI) of 26.4. Complete obstruction of the soft palate was observed in 51/56 patients (91%), oropharyngeal obstruction in 15/56 patients (27%), tongue base obstruction in 23/56 patients (41%), and epiglottic collapse in 16/56 patients (29%). PAP was most effective in cases of complete oropharyngeal obstruction, and least effective in cases of epiglottic collapse, where it was ineffective in 11/16 patients. DISE with PAP is a simple diagnostic method that can be helpful for identifying anatomic and dynamic reasons for PAP intolerance. The main indication is ineffective PAP treatment.
- Publikační typ
- časopisecké články MeSH
