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Probing for nasolacrimal duct obstruction with intravenous propofol sedation
M Movaghar1, S Kodsi, C Merola
1Department of Ophthalmology and the Department of Pediatrics, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
Insights
Late nasolacrimal duct probing using propofol sedation is effective for neonates, offering a faster, cheaper alternative to general anesthesia. This method significantly reduces procedure and recovery times while maintaining high success rates.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Anesthesiology
Background:
- Nasolacrimal duct obstruction affects 5-6% of neonates.
- Treatment options include spontaneous resolution, early intervention without anesthesia, or late probing under general anesthesia.
- Late probing is often considered for persistent cases after spontaneous resolution fails.
Purpose of the Study:
- To evaluate late nasolacrimal duct probing under intravenous propofol sedation.
- To compare the efficacy, procedure time, recovery time, and cost of propofol sedation versus general inhalational anesthesia for this procedure.
Main Methods:
- Retrospective review of patient charts for children undergoing nasolacrimal duct probing.
- Comparison of procedure and cost data between patients sedated with propofol and those under general anesthesia.
Main Results:
- 84% of 31 eyes treated with propofol sedation showed symptom resolution.
- Average procedure time was 10.5 minutes with propofol vs. 43.6 minutes with general anesthesia.
- Average recovery time was 13.6 minutes with propofol vs. 121.1 minutes with general anesthesia. Cost was one-third lower with propofol.
Conclusions:
- Late nasolacrimal duct probing under propofol sedation is a safe and effective alternative.
- This approach offers significant reductions in procedure and recovery times.
- Propofol sedation provides a cost-effective option compared to general inhalational anesthesia for late nasolacrimal duct probing.
Background:
Nasolacrimal duct obstruction occurs in 5% to 6% of neonates. Many studies advocate the probing of nasolacrimal duct obstruction under general inhalational anesthesia in patients at a late age (12 to 13 months) because a high percentage will resolve spontaneously. Others support early surgical intervention in patients aged younger than 6 to 9 months without anesthesia. We present late nasolacrimal duct probing under intravenous propofol sedation as an alternative approach to the treatment of nasolacrimal duct obstruction with a decrease in cost and time compared with probing under general inhalational anesthesia.
Methods:
We made a retrospective review of patient charts of children who underwent nasolacrimal duct probing with intravenous propofol sedation from April 1996 to September 1997. Procedure time and cost of procedure were compared for patients who had probings under propofol sedation to patients who had probings under general anesthesia.
Results:
A total of 22 patients (31 eyes) underwent nasolacrimal duct probing with propofol sedation; the patients' ages ranged from 11.5 to 39 months (average age, 17.8 months). Twenty-six (84%) of 31 eyes had resolution of the symptoms. The average total time for procedure under propofol sedation was 10.5 minutes, compared with 43.6 minutes under general inhalational anesthesia. The average total recovery time under propofol sedation was 13.6 minutes, compared with 121.1 minutes with general inhalational anesthesia. The cost of probing under propofol sedation was one third less than the cost of probing under general inhalational anesthesia.
Discussion:
Late probing for nasolacrimal duct obstruction under intravenous propofol sedation is comparable in efficacy to late probing under general inhalational anesthesia with a shorter time for the procedure and decreased expense.