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Published on: November 6, 2019
The safety of conscious sedation in peritonsillar abscess drainage
P W Bauer1, J E Lieu, D L Suskind
1Division of Pediatric Otolaryngology, St Louis Children's Hospital, Washington University School of Medicine, One Children's Place, Suite 3S-35, St Louis, MO 63110-1077, USA. bauerp@msnotes.wustl.edu
Insights
Conscious sedation is a safe method for draining peritonsillar abscesses (PTAs) in children. Combining this study
Area of Science:
- Pediatric Emergency Medicine
- Otolaryngology
- Sedation Anesthesia
Background:
- Peritonsillar abscesses (PTAs) are common in children.
- Drainage is the primary treatment for PTAs.
- The safety of conscious sedation for PTA drainage needs further evaluation.
Purpose of the Study:
- To assess the safety of conscious sedation during peritonsillar abscess drainage in pediatric patients.
- To determine complication rates associated with this procedure.
Main Methods:
- Retrospective review of medical records for 91 children with PTAs treated in a pediatric emergency department.
- Analysis of conscious sedation records and patient outcomes.
- Comparison with a previous study of 30 PTA drainage episodes.
Main Results:
- No major complications were observed in 62 conscious sedation episodes for PTA drainage.
- A combined analysis of 92 episodes showed a 1-sided upper 95% confidence limit of 3.2% for major complications.
- Minor complications and admission rates were also documented.
Conclusions:
- Conscious sedation is a safe and effective technique for peritonsillar abscess drainage in pediatric patients.
- This approach minimizes major complications when performed by a dedicated team.
- Further research can build upon these findings to optimize PTA management.
Objective:
To demonstrate the safety of conscious sedation in draining peritonsillar abscesses (PTAs).
Design:
Children diagnosed as having a PTA in the pediatric emergency department were identified, and their medical records were retrospectively reviewed. Results of the present study were compared with those of a previous report.
Setting:
A tertiary referral children's hospital pediatric emergency department.
Participants:
Ninety-one consecutive children initially evaluated in the emergency department and managed for a PTA.
Interventions:
Peritonsillar abscess incision and drainage with or without sedation. A team of physicians whose activities were documented on a formal conscious-sedation record was present. Patients were monitored for major and minor complications.
Outcome Measures:
The primary outcome measures were major and minor complications. Secondary outcome measures were recurrence of PTA and the need for admission.
Results:
There were 62 episodes of conscious sedation for drainage of a PTA. Among the 91 patients, 3 had a recurrence and 24 were admitted after the procedure. A previous study evaluated 30 episodes of conscious sedation for drainage of a PTA. No major complications occurred in either series. Combining the previous data with the present data produced 92 episodes of conscious sedation for drainage of a PTA. The 1-sided upper 95% confidence limit for the rate of major complications is 3.2%.
Conclusion:
Our series, when combined with previously published data, demonstrates that conscious sedation can be safely used when draining a PTA in pediatric patients.
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