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Samuel G. Shiley, MD; Kirk Lalwani, MD; Henry A. Milczuk, MD

Arch Otolaryngol Head Neck Surg. 2003;129:637-641.

Objective  To compare efficacy, safety, and hospital charges for common pediatric otolaryngology procedures with the use of intravenous sedation (IVS) vs general anesthesia (GA).

Design  Retrospective chart study.

Setting  Hospital-based pediatric otolaryngology practice.

Patients  Patients younger than 18 years who underwent tympanostomy tube removal and/or patch myringoplasty with absorbable gelatin sponge, nasal ciliary biopsy, fine-needle aspiration, or other minor procedures between September 1, 1998, and August 31, 2001.

Interventions  Procedures performed in 2 settings: outpatient clinic with IVS or operating room with GA.

Main Outcome Measures  Procedure completion rate, tympanic membrane perforation rate after ear procedures, complications, and hospital charges.

Results  Of 103 procedures, 54 were performed with IVS and 49 with GA. Within the GA group, 32 of 49 patients had additional operations performed and were excluded from analysis of safety and hospital charges. Procedure completion rate was 100% in both groups. The most common procedure was tympanostomy tube removal with patch myringoplasty (IVS, 52 ears; GA, 42 ears). The rate of persistent tympanic membrane perforation was similar between these groups (IVS, 7 [16%] of 45 ears; GA, 5 [15%] of 33; P = .96). All complications were minor and occurred at similar rates (IVS, 10 [19%] of 54 ears; GA, 3 [18%] of 17; P = .94). These events included hypoxia, airway obstruction, and bradycardia, all of which resolved spontaneously or responded to noninvasive interventions such as oxygen or repositioning. Average hospital charges were significantly higher for the GA group (IVS, $356.22; GA, $1516.55; P<.001).

Conclusion  Various procedures can be performed safely, effectively, and with decreased hospital charges with the use of IVS administered by a pediatric sedation service.

From the Departments of Otolaryngology–Head and Neck Surgery (Drs Shiley and Milczuk) and Anesthesiology (Dr Lalwani), Oregon Health & Science University, Portland. The authors have no relevant financial interest in this article.

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