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Anesthetic Complications of Tympanostomy Tube Placement in Children
Karen K. Hoffmann, MD;
G. Kevin Thompson, MD;
Bonnie L. Burke, MS;
Craig S. Derkay, MD
Arch Otolaryngol Head Neck Surg. 2002;128:1040-1043.
Objective To determine the incidence of perioperative anesthesia complications
during bilateral myringotomy with tympanostomy tube placement (BMTT).
Setting Tertiary care children's hospital where otolaryngology attending physicians
and residents performed surgical procedures. Anesthesia providers included
pediatric anesthesiologists, residents, nurse anesthetists, and students.
Methods Medical record review was performed for a consecutive series of 3198
children undergoing BMTT (1000 prospectively, 2198 retrospectively). For the
prospectively studied patients, major adverse events, which included laryngospasm
and stridor, and minor adverse events, including upper airway obstruction,
prolonged recovery, emesis, and persistent postprocedural agitation, were
noted. Also recorded were the patient's American Society of Anesthesiologists
(ASA) physical class status, age, concurrent medical conditions, and type
of anesthesia provider.
Results Fewer than 9% of prospectively studied pediatric patients experienced
a minor adverse event, whereas a major event occurred in 1.9%. Eighty-one
percent of the events experienced were attributable to agitation or prolonged
recovery. Neither ASA status (P = .38), age (P = .15), nor type of anesthesia provider (P = .06) were significantly related to the occurrence of an adverse
event. However, a child with an acute or chronic illness has 2.78 times the
odds of experiencing an adverse event compared with a child with no illness
(P<.001).
Conclusions 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.
From the Department of Otolaryngology, Eastern Virginia Medical School
(Drs Hoffmann and Derkay), and Departments of Pediatric Anesthesiology (Dr
Thompson) and Clinical Outcomes, Research, and Epidemiology (Ms Burke), Children's
Hospital of the King's Daughters, Norfolk, Va.
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