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Ventilation tube insertion using topical anaesthesia in children
1Department of Otolaryngology, Glasgow Royal Infirmary.
Insights
Topical anesthesia with EMLA cream is effective for ventilation tube insertion in children aged 3-12 years. This method is well-tolerated with proper technique, showing a low failure and complication rate.
Area of Science:
- Pediatric Otolaryngology
- Anesthesiology
Background:
- Topical anesthesia with EMLA cream is a standard procedure for ventilation tube insertion in adults.
- Its efficacy and safety in pediatric patients require specific evaluation.
Purpose of the Study:
- To assess the effectiveness and safety of EMLA cream for topical anesthesia during ventilation tube insertion in children.
- To identify optimal application parameters for successful pediatric procedures.
Main Methods:
- A prospective study involving 103 children (aged 3-12 years) undergoing ventilation tube insertion.
- Application of EMLA cream as a topical anesthetic prior to the procedure.
- Monitoring for procedural success, failure, and any adverse events.
Main Results:
- A high success rate of 93.2% (7 failures out of 103 patients).
- Minor complications occurred in only two patients.
- The technique was well-tolerated when suction was avoided and cream penetration time exceeded two hours.
Conclusions:
- EMLA cream is a safe and effective topical anesthetic for ventilation tube insertion in children.
- Adherence to specific procedural guidelines, including adequate penetration time and avoiding suction, is crucial for optimal outcomes.
- The use of 'T' myringotomy is recommended to minimize intraoperative stress on the tympanic membrane.
Abstract:
Topical anaesthesia using EMLA cream is an established anaesthetic technique for ventilation tube insertion in adults. We report its use in 103 children (age range 3-12 years). Failure occurred in seven patients (6.8 per cent); complications occurred in two patients and were of a minor nature. This technique appears well tolerated provided the operator avoids the use of suction and allows a cream penetration time of greater than two hours. The use of a 'T' myringotomy is also recommended, to reduce tension on the drum at tube insertion.