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Conscious sedation: a new approach for peritonsillar abscess drainage in the pediatric population
D L Suskind1, J Park, J F Piccirillo
1St Louis Children's Hospital, Washington University School of Medicine, Division of Pediatric Otolaryngology, MO, USA.
Insights
Conscious sedation (CS) safely and effectively aided incision and drainage (I&D) for pediatric peritonsillar abscesses (PTAs). This method reduced complications and hospital admissions, offering a promising alternative for children.
Area of Science:
- Pediatric Emergency Medicine
- Anesthesiology
- Otolaryngology
Background:
- Peritonsillar abscesses (PTAs) are common in children, often requiring incision and drainage (I&D).
- Traditional I&D can be distressing for pediatric patients, necessitating effective sedation strategies.
Purpose of the Study:
- To evaluate the safety and efficacy of conscious sedation (CS) during emergency department (ED) I&D of pediatric PTAs.
- To compare outcomes of I&D with CS versus without CS in children.
Main Methods:
- Retrospective chart review of 52 children with PTAs or peritonsillar cellulitis over 33 months.
- Comparison of outcomes between 30 PTAs drained with CS and 25 drained without CS.
- CS involved a multidisciplinary team and a standardized protocol using midazolam, ketamine, and glycopyrrolate.
Main Results:
- No major airway complications occurred with CS; one minor event (transient oxygen desaturation) resolved spontaneously.
- Higher purulence yield in the CS group (97%) compared to the non-CS group (64%) (P = .002).
- Lower ED admission rates (10% vs. 24%) and recurrence rates (3.3% vs. 8%) in the CS group, though not statistically significant.
Conclusions:
- Conscious sedation appears to be a safe and effective method for I&D of pediatric PTAs in the ED.
- CS offers potential benefits including reduced patient anxiety and pain.
- This approach represents a promising advancement in managing pediatric PTAs.
Objective:
To assess the safety and efficacy of conscious sedation (CS) in children undergoing emergency department incision and drainage (I&D) of peritonsillar abscesses (PTAs).
Design:
A 33-month retrospective chart review of all children presenting to the emergency department with the diagnosis of a PTA or peritonsillar cellulitis. Children who underwent CS prior to I&D were compared with children without CS for complications and efficacy.
Setting:
St Louis Children's Hospital, an academic tertiary care pediatric hospital.
Patients:
Fifty-two children were enrolled; 30 PTAs were drained with CS in 27 children (3 underwent I&D twice), and 25 PTAs were drained in 25 children without CS.
Interventions:
The CS team included an otolaryngologist, a pediatric emergency department physician, and a registered nurse. A standardized CS protocol assessing vital signs and level of consciousness was employed during each procedure. A combination of midazolam, ketamine hydrochloride, and glycopyrrolate was used in appropriately weighted calculated doses. Patients were assessed for major and minor airway complications.
Main Outcome Measures:
Airway complications related to CS were reviewed. Patients who underwent I&D with and without CS were compared with regard to purulent drainage.
Results:
There were no major airway complications in patients undergoing I&D with CS. There was 1 minor complication in this group, oxygen desaturation to 88%, which resolved with stimulation. Of the 55 procedures, 45 (82%) yielded purulence: 29 (97%) of 30 in the CS group and 16 (64%) of 25 in the non-CS group (chi2 = 9.8; P = .002). Of those children undergoing CS, 3 (10%) of 30 were admitted to the hospital from the emergency department as compared with 6 (24%) of 25 without CS (chi2 = 1.95; P = .16). In the CS group, PTAs had a low recurrence rate of 1 (3.3%) of 30 compared with 2 (8%) of 25 in the non-CS group (chi2 = 0.57; P = .45). No one in the CS group required a secondary procedure under general anesthesia.
Conclusions:
This preliminary study demonstrates CS to be a potentially safe and efficacious approach to drainage of PTAs in children. Given its efficacy and its associated lower levels of anxiety and pain for the patient, CS seems to be a promising new approach to caring for children with PTAs.
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