Author(s)
Catherine F. Roy, MD(c)1
Sena Turkdogan, MD1
Lily H. P. Nguyen, MD, MSc, FRCPS1,2
Jeffrey Yeung, MD, FRCPS1,2
Affiliation(s)
1Department of Otolaryngology - Head and Neck Surgery, McGill Univ., Montreal, Canada.;
2 Department of Pediatric Surgery - McGill Univ., Montreal, Canada
Abstract:
Introduction: Limited accessibility to operating room (OR) time for elective procedures in our provincial context has fueled the search for alternate surgical settings. Our pediatric academic hospital has recently adopted a novel protocol whereby healthy children may undergo myringotomy and tympanostomy tube insertion under procedural sedation in minor procedure rooms (MPRs). The aim of this study is to explore the potential benefit of our local practice in reducing surgical wait times for this patient population, while exploring the safety and tolerability of the procedure.
Methods: A retrospective study of all children having undergone elective bilateral myringotomy and tube insertion at one academic pediatric hospital between September 2017 and May 2019 was conducted. Children in the main OR had received standard anesthetic regimens, while patients in the MPR had been sedated using 1-5mg/kg of intravenous ketamine administered by a pediatric emergency physician. The main outcome was length of time from initial surgical request to the operation. Secondary outcomes included surgical and anesthesia-related complications, as well as anti-emetic use in the post-anesthesia care unit.
Results: 562 patients were included in the study. Of these, 449 patients underwent the procedure in the main OR, while the remaining 113 patients were operated on in the MPR. Use of the MPR setting by 2 of 11 pediatric otolaryngologists in our institution effectively reduced our overall surgical wait time by 53 days (p<0.0001). No surgical complications occurred in the MPR group, while only 2 patients had minor complications in the main OR. No severe anesthesia-related events were reported in either group, however rates of anti-emetic use were increased in the MPR group (14.3% vs 3.3%, p<0.0001).
Conclusion: Tympanostomy tube insertion under procedural sedation in MPRs is a safe alternative for children with no or few comorbidities, allowing to effectively reduces overall surgical wait times. However, standardized anesthetic protocols are required to minimize post-operative nausea.