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Published on: March 2, 2020
Conscious Sedation for Pediatric Peritonsillar Abscess: Comparison of Anesthetic Approaches
M Elise Graham1, Abigail K Neal2, Ian C Newberry2
11 Division of Otolaryngology-Head and Neck Surgery, Western University and London Health Sciences Centre, London, Ontario, Canada.
Insights
Conscious sedation (CS) for pediatric peritonsillar abscess (PTA) incision and drainage (I&D) offers similar tolerance and success to awake or general anesthesia (GA). While CS had some manageable complications, it showed a trend toward fewer emergency department returns.
Area of Science:
- Pediatric Otolaryngology
- Emergency Medicine
- Anesthesiology
Background:
- Peritonsillar abscesses (PTAs) are common in pediatric patients.
- Incision and drainage (I&D) is a standard treatment for PTAs.
- Anesthesia choice for pediatric PTA I&D impacts tolerance, safety, and cost.
Purpose of the Study:
- To compare the efficacy, safety, and cost of I&D for pediatric PTAs.
- To evaluate outcomes under conscious sedation (CS) versus unsedated (awake) and general anesthesia (GA).
Main Methods:
- Retrospective case series with chart review of 188 pediatric patients (<18 years) treated for PTAs.
- Patients were stratified into awake, CS, and GA groups.
- Outcomes included procedure tolerance, return to ED within 15 days, complications, and costs.
Main Results:
- Procedure tolerance was high (>92%) across all groups (P = .60).
- CS group showed a trend towards fewer ED returns (0%) compared to awake (5.2%) and GA (9.1%) (P = .06).
- Complications occurred in 9.6% of the CS group (apnea, dental trauma, hypotension, desaturation), but not in awake or GA groups (P = .02).
- Cost was highest for GA and lowest for awake procedures (P < .0001).
Conclusions:
- Conscious sedation (CS) is a viable option for pediatric PTA I&D, with comparable tolerance and success rates.
- CS demonstrated a trend for fewer returns to the emergency department.
- While complications were noted in the CS group, they were manageable, suggesting CS is a safe alternative.
Objective:
To compare the efficacy, safety, and cost of incision and drainage (I&D) for pediatric patients with peritonsillar abscesses (PTAs) under conscious sedation (CS) versus unsedated (awake) and general anesthesia (GA).
Study Design:
Case series with chart review.
Setting:
Tertiary pediatric hospital.
Subjects And Methods:
Records for all pediatric patients (<18 years) treated for PTAs in the emergency department from 2005 to 2015 were reviewed and stratified into awake, CS, and GA groups for comparison. The primary outcome measure was procedure tolerance, with secondary measures including return to the emergency department within 15 days, complications, and facility costs associated with treatment.
Results:
A total of 188 patients were identified. The median age was 14 years (interquartile range, 9-16). Awake drainage with injected local anesthetic was used in 115 children; 62 underwent CS; and 11 underwent GA. Over 92% of the children tolerated I&D regardless of anesthesia, with no difference among groups ( P = .60). None of those who underwent I&D via CS returned to the emergency department within 15 days of the procedure, as compared with 5.2% for the awake group and 9.1% for the GA group ( P = .06). None in the GA or awake group had a complication associated with the procedure, as opposed to 9.6% in the CS group ( P = .02). Complications included apnea and dental trauma (2 children each) and transient hypotension and desaturation (1 each). Cost was highest in the GA group and lowest for the awake group ( P < .0001).
Conclusion:
CS for PTA I&D is a viable treatment option with tolerance and success similar to that of the awake and GA groups. Complications were observed for those who underwent CS, but they were manageable.
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