Related Experiment Videos
Anaesthesia for insertion of bone-anchored hearing aids in children: a 7-year audit
S E Jones1, U Dickson, A Moriarty
1Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK.
Insights
This study audited anesthesia for pediatric bone-anchored hearing aid surgery, finding airway complications and nausea/vomiting were most common. Anesthesia techniques evolved towards laryngeal mask airways and propofol over seven years.
Area of Science:
- Pediatric Anesthesiology
- Otolaryngology
- Medical Auditing
Background:
- Bone-anchored hearing aids (BAHA) require anesthesia in children, often with complex head and neck syndromes.
- Children with craniofacial anomalies present unique anesthetic challenges.
- Auditing anesthetic practices is crucial for improving patient safety and outcomes.
Purpose of the Study:
- To audit anesthetic techniques and outcomes for pediatric BAHA insertion.
- To identify common complications and pre-existing conditions in this patient group.
- To track changes in anesthetic management over a 7-year period.
Main Methods:
- Retrospective audit of 102 anesthetics in 43 children (23 months–14 years) undergoing BAHA insertion.
- Data collected included patient demographics, pre-existing conditions, anesthetic technique, intubation grade, complications, and discharge status.
- Analysis of trends in airway management and anesthetic agents over 7 years.
Main Results:
- Forty children (93%) had recognized head and neck syndromes; 19% had congenital heart disease.
- Sixteen patients (15%) had difficult intubations (Grade 3 or 4).
- Intraoperative airway complications occurred in 5.9%, and postoperative nausea/vomiting in 17.6%.
- Laryngeal mask airway use increased, replacing tracheal intubation; propofol replaced inhalational induction agents.
- 71% of surgeries were performed as day cases.
Conclusions:
- Anesthetic management for pediatric BAHA insertion has evolved towards safer airway techniques and agents.
- Despite complex patient profiles, day case surgery is feasible.
- Airway-related complications and postoperative nausea/vomiting remain key areas for vigilance and management.
Abstract:
Forty-three children, aged 23 months to 14 years, received 102 anaesthetics for insertion of bone-anchored hearing aids, each lasting approximately 30-60 min. Forty of the children had a recognised syndrome involving the head and neck, including Goldenhar's and Treacher Collin's syndrome. The incidence of congenital heart disease was 19%. Pre-existing conditions, anaesthetic technique, grade of intubation, complications and discharge were audited. Sixteen of the patients were classified as Grade 3 or 4 intubations. Over the 7 years, laryngeal mask airway usage increased for airway maintenance rather than tracheal intubation, as did the use of propofol for induction rather than inhalational methods. Intra-operative complications (5.9%) were related to the airway, and postoperative ones (17.6%) mainly to nausea and vomiting. Surgery was performed as a day case in 71% of the patients despite some long-distance travel.