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Tonsillectomy is one of the most commonly performed surgeries in North America. Guidelines exist for surgical candidacy for pediatric patients, but to date, there exists significant controversy and no clear guidelines advising physicians on treating pain post-tonsillectomy. Pain is the most frequent and potentially morbid complication of tonsillectomy, as it triggers return visits to physicians and hospitals following surgery, and can result in the need for hospital admission for hydration and pain control. In fact, a main point of controversy surrounds the use of a large class of analgesics known as non-steroidal anti-inflammatory drugs (NSAIDs), due to the potential for increased risk of bleeding as a result of their anti-platelet activity. However, NSAIDs have been shown to have a notable analgesic benefit in other surgical fields without conferring a significant bleeding risk. Moreover, they are known for their opioid-sparing effect, which is favored due to the many side-effects of opioids. Therefore, we undertook a systematic review of the literature to investigate the question of analgesic benefit for NSAIDs compared to other analgesics, and found that they were not different than opioids at treating post-tonsillectomy pain. However, the evidence available to answer this question was often flawed, warranting further investigation into this question. We were also especially interested in investigating commonly used analgesics such as ibuprofen and acetaminophen, so we devised a protocol that included these two medications. This protocol compares ibuprofen and acetaminophen to acetaminophen alone and seeks to show a significant opioid-sparing effect for ibuprofen. Ultimately, this topic is important because of the frequency with which tonsillectomies are performed and the importance of pain control following this procedure. / Thesis / Master of Science (MSc) / Tonsillectomy is the surgery that completely removes the tonsil from the throat, and many children and adults undergo this procedure for various reasons including infections, sleeping problems and other. This surgery has several side effects including pain, dehydration and bleeding. Pain is the most frequent of all these side effects, and can result in significant disturbances in the recovery experience, as well as cause the patient to require hospital visits and admission. Therefore pain control is important, and can be achieved incorporating medications such as non-steroidal anti-inflammatory drugs into the post-operative analgesic regimen. We investigated the role that these medications can play in relieving pain in this setting, and found that these are no different than opioids, such as morphine and codeine, the latter of which have many side-effects including breathing problems, constipation, itchiness, nausea, and others. However, there wasn't enough evidence to make definitive conclusions regarding the amount of opioids that can be avoided with the use of non-steroidal anti-inflammatory drug. Therefore, we designed a protocol for a randomized study to better understand this area that is so far little understood. The results of this study could help optimize pain control measures following tonsillectomy, and change the practice of surgeons favoring an evidence-based approach.

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The n-butanol extract of aerial parts of Cordyline australis demonstrated antifungal activity. n-Butanol and chloroform extracts of dried or fresh leaves of C. australis afforded a steroidal glycoside, which was identified as 5α-spirost-25(27)-en-3β-ol 3-O{O-α-L-rhamnopyranosyl-(1→2)-β-D-glucopyranoside}, saponin 1. This spirostanol glycoside showed strong antifungal activity towards Trichophyton mentagrophytes and some aspecific activity and cytotoxicity against MRC5 cell. The chloroform extract of fresh leaves of C. australis yielded a second new spirostanol glycoside which was identified as 5α-spirost-25(27)-ene-1β,3β-diol 1-{O-α-L-rhamnopyranosyl-(1→2)-β-D-fucopyranoside}, saponin 2. The n-butanol extracts of senescent leaves of C. australis afforded a third new spirostanol glycoside that was identified as 5α-spirost-25(27)-ene-1β,3β-diol 1-{O-β-D- fucopyranoside, saponin 3. A mixture of two isomeric flavonoid glycosides was isolated from dried leaves of C. australis and shown to be a ca 1:1 mixture of isorhamnetin-3-O-{O-α-L-rhamnopyranosyl-(1→6)-β-D-glucopyranoside}, 4 and isorhamnetin-3-O-{O-α-L-rhamnopyranosyl-(1→6)-β-D-galactopyranoside}, 5. Three other known steroidal glycosides, β-sitosterol glucoside, 6, prosapogenin A of dioscin, 7, and trillin, 8 were also isolated from the leaves of C. australis. The n-butanol extract of dried stems of C. australis afforded (25S)-5α-spirostane-1β,3α-diol 1-{O-β-D-glucopyranoside}, 9. This spirostanol glycoside showed moderate cytotoxicity against Herpes simplex type I virus (ATCC VR733) and Polio Virus Type I (Pfiser vaccine strain).

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Thesis (Ph.D.)--Aberdeen University, 2008. / Title from web page (viewed on Dec. 1, 2009). Includes bibliographical references.