Anesthesia administered for placement of tympanostomy tubes by physicians who specialize in the care of children in a tertiary care children's hospital is safe. The most significant predictor of a minor anesthetic event during BMTT is the presence of a preexisting medical condition or concurrent acute illness.

Pectus excavatum is an anterior chest wall deformity that now can be corrected with a minimally invasive technique known as the Nuss procedure. Patient criteria and assessment for this new surgical procedure are defined clearly in advance to ensure the need for surgical intervention. A multidisciplinary team approach has been established at Children's Hospital of The King's Daughters, Norfolk, Va. Team members work cooperatively throughout the perioperative cycle, addressing not only the surgical procedure but also pain management and postoperative recovery. This dedicated team approach helps ensure a successful outcome for the patient.

Bilateral myringotomy with tympanostomy tube placement is the second most frequently performed pediatric surgical procedure, next to circumcision. Postoperative pain relief for children undergoing this procedure has been an ongoing concern. The authors undertook a prospective, randomized, double-blind, placebo-controlled clinical study in 200 consecutive children to investigate the efficacy of oral acetaminophen, acetaminophen with codeine, ibuprofen, and placebo administered preoperatively in relieving postoperative pain in children undergoing this procedure. All children received topical analgesia consisting of antibiotic eardrops mixed with 4% lidocaine intraoperatively. There was no significant difference in postoperative pain score between the four groups (P > 0.4447). Thus it is likely that the intraoperative administration of antibiotic eardrops mixed with 4% lidocaine is all that is required to alleviate postoperative pain in children undergoing myringotomy with tympanostomy tube placement. Preoperative oral analgesics are apparently of little added benefit.

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