Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives

Abstract

PurposeMyringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT) surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction.Recent findingsThis review summarizes recently published studies about the long-term effects of general anesthesia in young children, novel approaches to preoperative fasting and simplified approaches to the assessment and management of emergence delirium (ED) and emergence agitation (EA). New developments in perioperative ambulatory care, including management of comorbidities and day care unit logistics, are discussed.SummaryLong-term follow-up of children exposed to general anesthesia before the age of 4 years has limited impact on academic achievement or cognitive performance and should not delay the treatment of common ENT pathology, which can impair speech and language development. A more liberal approach to fasting, employing a 6–4–0 regime allowing children fluids up until theater, may become an accepted practice in future. ED and EA should be discriminated from pain in recovery and, where the child is at risk of harm, should be treated promptly. Postoperative pain at home remains problematic in ambulatory surgery and better parental education is needed. Effective ambulatory care ultimately requires a well-coordinated team approach from effective preassessment to postoperative follow-up.

Myringotomy and insertion of grommets as day surgery: a case study

“…Clinical judgement should be taken into account at all times, regardless of the PEWS score (HSE, 2017). Jack's score was zero without any signs of active infection indicating his observations are optimal for surgery to proceed as planned (Robinson and Engelhardt, 2017).…”

“…Environment: Jack's temperature is taken using a child sized tympanic thermometer (RCN, 2017), it is 36.9 degrees Celsius (within the normal range) (HSE, 2017). Any elevation in temperature is important to note as contraindications to paediatric ambulatory surgery include an active infection (Robinson and Engelhardt, 2017). Pyrexia prior to surgery may also lead to post-operative complications (Macqueen, Bruce and Gibson, 2012).…”

“…The procedure is relatively short and performed safely under general anaesthetic as a day case. It involves making an incision in the tympanic membrane, allowing access to the middle ear and drainage of fluid (myringotomy) (Robinson and Engelhardt, 2017). The tiny drainage tube, known as a grommet, is then placed in the tympanic membrane to allow for the fluid to continue to drain and air to circulate following surgery (Robinson and Engelhardt, 2017; Health Information and Quality Authority (HIQA), 2013).The grommet usually remains in place for at least six months to a year.…”

Analgesia para cirugía pediátrica ambulatoria

“…El uso de lidocaína tópica al 2%-4% en miringotomías ha demostrado reducir los requerimientos de analgésicos en el posoperatorio y proporcionar un alivio del dolor equivalente al paracetamol [36].…”

Transient facial paralysis after myringotomy and ventilation tube insertion under sedation with sevoflurane inhalation and four-quadrant blocks with lidocaine: a case report

“…Drainage of effusion in the middle ear via a small incision in the tympanic membrane leads to resolution of COM. This procedure is performed under general anesthesia or sedation combined with infiltration of local anesthetic [1,2]. In this case report, we report a pediatric patient with transient facial paralysis after myringotomy and insertion of a ventilation tube using sevoflurane inhalation and local infiltration with lidocaine.…”