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Sedation protocols for Ponseti clubfoot Achilles tenotomy
Noam Bor1, Yeshayahu Katz, Oded Vofsi
1Pediatric Orthopedic Unit, HaEmek Medical Center, Afula, 18101, Israel.
Purpose:
Ponseti clubfoot management requires percutaneous tenotomy in 90% of cases, typically with local anesthesia. We report two light sedation protocols for outpatient tenotomy.
Methods:
Operating room protocol: 24 patients (36 club feet; mean age at tenotomy, 70 days) underwent mask induction with oxygen/nitrous oxide. Pediatric intensive care unit protocol: five patients (eight club feet; mean age at tenotomy, 119 days) underwent intravenous propofol infusion with supplemental oxygen.
Results:
All patients were discharged several hours after surgery with no complications. Anesthesia that is administered intravenously might have less risk of bronchial reaction than anesthesia that is administered by inhalation.
Conclusions:
Our light sedation protocols offer safe alternatives to general anesthesia. Disadvantages include increased cost when compared with local anesthesia. Light sedation can be used effectively and has advantages when treating older infants who might struggle while under local anesthesia.
