Deep Sedation for Pediatric Parotid Sialendoscopy in Juvenile Recurrent Parotitis

Abstract

Sialendoscopy is a minimally invasive diagnostic and therapeutic tool for juvenile recurrent parotitis (JRP); the procedure is under general anesthesia, but local anesthesia has been used for sialendoscopy in children >8 years. Based on the experience in children with sedation for gastrointestinal endoscopy, we investigated the reliability and safety of deep sedation for sialendoscopy in JRP. Six children (3 females, 6–13 years) with episodes of parotid swelling underwent interventional (duct dilation and steroid irrigation) sialendoscopy with intravenous bolus of 1 mg/kg propofol and 1 mcg/kg fentanyl, and continuous infusion of 2 mg/kg/h propofol. Sialendoscopy under deep sedation was successfully performed in all the patients; the procedure was well tolerated, without any adverse effects. One event of full awakening was registered and promptly solved without needing to interrupt the procedure. Effectiveness of sialendoscopy under deep sedation was subjectively attested by high positive scores obtained at post-operative standardized questionnaires administered to the patients and their parents, and objectively by the lack of clinical recurrences during the follow-up. The combination of propofol and fentanyl seems to be a reliable and safe means of sedating children with JRP undergoing sialendoscopy.

Prognostische Einflussfaktoren auf den Erfolg der Sialendoskopie bei Sialolithiasis

“…Laut Autoren reduzierte die Sedierung die Krankenhausaufenthaltsdauer um 141 Minuten, die Anästhesiedauer um 46 Minuten, die Operationsdauer um 24 Minuten, die Aufenthaltsdauer im Operationssaal um 43 Minuten und Erholungszeitdauer um 56 Minuten, wobei die chirurgischen Ergebnisse ähnlich zwischen den beiden Gruppen waren. Andere Studien berichteten ebenso über die Durchführung einer Sialendoskopie in Sedierung 7 8 23 , sogar bei Kindern für die juvenile rezidivierende Parotitis 24 25 . Coniglio und Co-Autoren berichteten noch über eine Reduktion der Kosten bei Durchführung des Eingriffs in Sedierung 26 .…”

Recurrent obstructive salivary disease after sialendoscopy. A narrative literature review

“…Sialendoscopy is a valid and safe diagnostic and therapeutic tool for management of JRP; the procedure is usually performed under general anaesthesia, but local anaesthesia and deep sedation have been recently described 5 . Typical endoscopic features of JRP are whitish appearance of the duct wall, mucous plugs, duct kinking and fibrotic strictures; interventional sialendoscopy is essentially performed by hydraulic dilation of the duct system up to the tertiary ductal branches thanks to continuous irrigation with saline solution and final irrigation with steroids (usually dexamethasone) 39 .…”

“…Obstructive salivary gland disease is a relatively common event; it has been estimated, in England, that the incidence of symptomatic sialadenitis and sialolithiasis accounts for 27.5 and 31.5 per million population per annum respectively 1 ; stones are the main obstructive cause, especially in the submandibular gland (80%), followed by duct stenoses and anomalies 2 , autoimmune inflammatory disorders such as Sjogren’s disease and immunoglobulin (Ig) G4-related chronic sclerotising sialadenitis 3 , radio-iodine induced parotitis 4 , foreign bodies 4 , and juvenile recurrent parotitis (JRP) 5 . Over the last 20 years, interventional sialendoscopy has become the therapy of choice for management of obstructive salivary disorders, favouring a significant reduction in the number of patients undergoing traditional sialadenectomy 4 .…”

Treatment of juvenile recurrent parotitis with irrigation therapy without anesthesia

“…Hence, the risk for an injury of the ductal wall should be even lower than for sialendoscopy. In addition, it must be kept in mind that sialendoscopy in pediatric patients often requires general anesthesia [12,14,16,[20][21][22] depending on the age and compliance of the patient. In this context the results of two studies, performed by Papadopoulou-Alataki et al [23] and Konstantinidis et al [20] suggest, that local anesthesia may be useful only for patients older than 8 years.…”