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Intravenous sedation vs general anesthesia for pediatric otolaryngology procedures
Samuel G Shiley1, Kirk Lalwani, Henry A Milczuk
1Department of Otolaryngology--Head and Neck Surgery, Oregon Health & Science University, Portland, USA.
Insights
Pediatric otolaryngology procedures using intravenous sedation (IVS) are as effective and safe as general anesthesia (GA) but significantly reduce hospital charges. IVS offers a cost-effective alternative for minor procedures in children.
Area of Science:
- Pediatric Otolaryngology
- Anesthesia
- Health Services Research
Background:
- Pediatric otolaryngology procedures often require anesthesia.
- Intravenous sedation (IVS) and general anesthesia (GA) are common anesthetic options.
- Comparing the efficacy, safety, and cost of IVS versus GA is crucial for clinical decision-making.
Purpose of the Study:
- To compare the efficacy, safety, and hospital charges of common pediatric otolaryngology procedures performed under intravenous sedation (IVS) versus general anesthesia (GA).
Main Methods:
- Retrospective chart study of pediatric otolaryngology procedures.
- Procedures included tympanostomy tube removal, patch myringoplasty, nasal ciliary biopsy, and fine-needle aspiration.
- Comparison between procedures performed with IVS in an outpatient clinic and GA in an operating room.
Main Results:
- Procedure completion rates were 100% for both IVS and GA.
- Persistent tympanic membrane perforation rates were similar (16% for IVS vs. 15% for GA).
- Complication rates were comparable and minor for both groups, with significantly lower hospital charges for IVS ($356.22) compared to GA ($1516.55).
Conclusions:
- Intravenous sedation is a safe and effective alternative to general anesthesia for various pediatric otolaryngology procedures.
- Utilizing IVS administered by a pediatric sedation service can lead to decreased hospital charges.
- IVS offers a cost-effective approach without compromising procedural outcomes or patient safety.
Objective:
To compare efficacy, safety, and hospital charges for common pediatric otolaryngology procedures with the use of intravenous sedation (IVS) vs general anesthesia (GA).
Design:
Retrospective chart study.
Setting:
Hospital-based pediatric otolaryngology practice.
Patients:
Patients younger than 18 years who underwent tympanostomy tube removal and/or patch myringoplasty with absorbable gelatin sponge, nasal ciliary biopsy, fine-needle aspiration, or other minor procedures between September 1, 1998, and August 31, 2001.
Interventions:
Procedures performed in 2 settings: outpatient clinic with IVS or operating room with GA.
Main Outcome Measures:
Procedure completion rate, tympanic membrane perforation rate after ear procedures, complications, and hospital charges.
Results:
Of 103 procedures, 54 were performed with IVS and 49 with GA. Within the GA group, 32 of 49 patients had additional operations performed and were excluded from analysis of safety and hospital charges. Procedure completion rate was 100% in both groups. The most common procedure was tympanostomy tube removal with patch myringoplasty (IVS, 52 ears; GA, 42 ears). The rate of persistent tympanic membrane perforation was similar between these groups (IVS, 7 [16%] of 45 ears; GA, 5 [15%] of 33; P =.96). All complications were minor and occurred at similar rates (IVS, 10 [19%] of 54 ears; GA, 3 [18%] of 17; P =.94). These events included hypoxia, airway obstruction, and bradycardia, all of which resolved spontaneously or responded to noninvasive interventions such as oxygen or repositioning. Average hospital charges were significantly higher for the GA group (IVS, $356.22; GA, $1516.55; P<.001).
Conclusion:
Various procedures can be performed safely, effectively, and with decreased hospital charges with the use of IVS administered by a pediatric sedation service.