Multiple surgeries in pediatric otolaryngology patients and associated anesthesia risks

Scholes, Melissa A.; Jensen, Emily L.; Polaner, David M.; Gao, Dexiang

doi:10.1016/j.ijporl.2018.07.017

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…This same study also showed that black patients underwent additional procedures at higher rates than other children. 27 Another study had shown that history of trisomy 21 could decrease likelihood of closure of the tympanic membrane after tympanostomy removal, which may necessitate another procedure. 28 Given significant increases in age and the proportion of black patients among CWDD, further investigation should be performed to determine rate of repeat procedures among this study population, as this study was unable to differentiate between first-time and repeat procedures within our study population.…”

Section: Discussionmentioning

confidence: 99%

Helping Children with Special Needs: Who Receives Tympanostomy Tubes?

Wassef

Dhaduk

Roy

et al. 2021

Ann Otol Rhinol Laryngol

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Objectives: Tympanostomy tubes can prevent sequelae of otitis media that adversely affect long term hearing and language development in children. These negative outcomes compound the existing difficulties faced by children who are already diagnosed with developmental disorders. This study aims to characterize this subset of children with developmental disorders undergoing myringotomy and tympanostomy tube insertion. Methods: A retrospective review using the Kids’ Inpatient Database (KID) was conducted, with codes from International Classification of Diseases, Ninth Revision used to query data from the years 2003 to 2012 to determine a study group of children with a diagnosis of a developmental disorder undergoing myringotomy and tympanostomy insertion. This group was compared statistically to patients undergoing these procedures who did not have a diagnosed developmental disorder. Results: In total, 21 945 cases of patients with myringotomy with or without tympanostomy tube insertion were identified, of which 1200 (5.5%) had a diagnosis of a developmental disorder. Children with developmental disorders had a higher mean age (3.3 years vs 2.9 years, P = .002) and higher mean hospital charges ($43 704.77 vs $32 764.22, P = .003). This cohort also had higher proportions of black (17.6% vs 12.3%, P < .001) and Hispanic (23.9% vs 20.6%, P = .014) patients, and had lower rates of private insurance coverage (39.6% vs 49%, P < .001). Conclusion: The population of children with developmental disorders undergoing myringotomy or tympanostomy tube placement has a different demographic composition than the general population and faces distinct financial and insurance coverage burdens. Further study should be done to assess if these differences impact long term outcomes.

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Section: Discussionmentioning

confidence: 99%

Helping Children with Special Needs: Who Receives Tympanostomy Tubes?

Wassef

Dhaduk

Roy

et al. 2021

Ann Otol Rhinol Laryngol

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“…Pediatric otolaryngology (ENT) procedures, especially bilateral myringotomies with tube placement (BMT) and tonsillectomies and adenoidectomies (T&A), are frequently performed at private academic children's hospitals in large cities and suburban areas. 1 In contrast, rural facilities may lack pediatric surgical subspecialties, therefore general anesthesiologists and otorhinolaryngologists have to perform these procedures. 2,3 Financial stress in rural areas has allowed large academic centers and hospital systems to expand into rural areas, thereby offering the potential opportunity for patients to be enrolled in clinical research studies.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 However, the infrastructure for Institutional Review Board (IRB) approved studies usually lacks in these rural hospitals. 6 Rural hospitals may need assistance in developing clinical research programs. The specific needs of their patients may differ from those in urban areas.…”

Section: Introductionmentioning

confidence: 99%

Development and implementation of new clinical research program in a rural hospital for children undergoing myringotomies or tonsillectomies and adenoidectomies

Bryan,

Wong,

Johnson

et al. 2023

Anaesth. pain intensive care

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Background & Objective: Pediatric sub-specialty procedures are usually performed in large hospitals by specialists. We aimed to develop a protocol in pediatric patients undergoing bilateral myringotomies (BMT) or tonsillectomies and/or adenoidectomies (T&A) in a rural community hospital. Methodology: An IRB-approved, prospective study was performed at Lexington Medical Center to examine the safety (S), emergence (E), and efficacy (E) (SEE) of an anesthetic protocol in patients under 7 y of age undergoing BMT or T&A. A non-specialist anesthesiology-based team performed the protocol related to SEE. Results: Out of 60 patients enrolled in the study, 4 (6.6%) desaturated (lowest SpO2 87%), and 6 (10%) had poor quality of emergence from anesthesia. The mean times for induction, emergence, and surgery for BMT were 4.8 ± 1.3, 4.2 ± 2.2, and 3.9 ± 1.0 min respectively. The mean times for induction-intubation, emergence-extubation, and surgery for T&A were 9.0 ± 2.9, 12.1 ± 6.8, and 14.6 ± 5.8 min respectively. Conclusion: The development of a clinical research program and study protocol was achieved for pediatric ENT procedures at a rural hospital. We found that Lexington Medical Center had a low incidence of desaturation, good quality of emergence from anesthesia, and efficacy. Key words: BMT: bilateral myringotomies; Desaturation; Emergence; Protocol; Pediatric; Citation: Bryan YF, Wong K, Johnson KN, Choi JA, Harris H, Galla J, Chapman B. Development and implementation of the new clinical research program in a rural hospital for children undergoing myringotomies or tonsillectomies and adenoidectomies. Anaesth. pain intensive care 2023;27(3):315−324. DOI: 10.35975/apic.v27i3.1501 Received: May 17, 2021; Reviewed: August 30, 2021; Accepted: May 10, 2023

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