Conscious Sedation for Pediatric Peritonsillar Abscess: Comparison of Anesthetic Approaches

2019 ◽  
Vol 160 (4) ◽  
pp. 706-711 ◽  
Author(s):  
M. Elise Graham ◽  
Abigail K. Neal ◽  
Ian C. Newberry ◽  
Matthew A. Firpo ◽  
Albert H. Park
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Case Series ◽  
Dental Trauma ◽  
Primary Outcome Measure ◽  
Peritonsillar Abscess ◽  
Incision And Drainage ◽  
Viable Treatment

Objective To compare the efficacy, safety, and cost of incision and drainage (I&D) for pediatric patients with peritonsillar abscesses (PTAs) under conscious sedation (CS) versus unsedated (awake) and general anesthesia (GA). Study Design Case series with chart review. Setting Tertiary pediatric hospital. Subjects and Methods Records for all pediatric patients (<18 years) treated for PTAs in the emergency department from 2005 to 2015 were reviewed and stratified into awake, CS, and GA groups for comparison. The primary outcome measure was procedure tolerance, with secondary measures including return to the emergency department within 15 days, complications, and facility costs associated with treatment. Results A total of 188 patients were identified. The median age was 14 years (interquartile range, 9-16). Awake drainage with injected local anesthetic was used in 115 children; 62 underwent CS; and 11 underwent GA. Over 92% of the children tolerated I&D regardless of anesthesia, with no difference among groups ( P = .60). None of those who underwent I&D via CS returned to the emergency department within 15 days of the procedure, as compared with 5.2% for the awake group and 9.1% for the GA group ( P = .06). None in the GA or awake group had a complication associated with the procedure, as opposed to 9.6% in the CS group ( P = .02). Complications included apnea and dental trauma (2 children each) and transient hypotension and desaturation (1 each). Cost was highest in the GA group and lowest for the awake group ( P < .0001). Conclusion CS for PTA I&D is a viable treatment option with tolerance and success similar to that of the awake and GA groups. Complications were observed for those who underwent CS, but they were manageable.

scholarly journals Masses of the Sternoclavicular Area: Case Series and Review of the Literature

2021 ◽  
Vol 15 ◽  
pp. 117955652110216
Author(s):  
Parisa Oviedo ◽  
Morgan Bliss
Keyword(s):  
English Language ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Case Series ◽  
Review Of The Literature ◽  
Incision And Drainage ◽  
Surgical Interventions ◽  
Ganglion Cysts ◽  
Icd 10 ◽  
Bronchogenic Cysts

Objective: Masses of the sternoclavicular area are rare, and are not well described in the literature. We aim to present a series of patients with masses in this location and to review all reported English language cases of sternoclavicular masses in pediatric patients. Methods: This is a case series of pediatric patients with masses of the sternoclavicular area presenting to a tertiary care pediatric hospital from 2010 through 2017. Data was collected by using ICD-9 and ICD-10 codes to query the electronic medical record. Chart review included age at presentation, mass characteristics, medical and surgical interventions, and pathology results. A review of the literature was then performed. Results: Ten patients with masses overlying the sternoclavicular area were identified. Four patients presented with abscess and were treated with incision and drainage. Three of these patients were then treated with staged excision once infection cleared. Two additional patients were treated with primary excision. Four patients were treated with observation. The most common histopathologic finding was epidermoid. One patient was found to have a dermoid cyst, and 1 had a congenital cartilaginous rest. Conclusion: Epidermoids and dermoids are the most common masses overlying the sternoclavicular area. Controversy remains regarding the embryologic origin of sternoclavicular masses. The differential for masses in this area also includes branchial remnants, bronchogenic cysts, ganglion cysts, or septic arthritis.

Pediatric Tracheostomy Decannulation: 11-Year Experience

2019 ◽  
Vol 161 (3) ◽  
pp. 499-506 ◽  
Author(s):  
Kristen L. Seligman ◽  
Bryan J. Liming ◽  
Richard J. H. Smith
Keyword(s):  
Failure Rate ◽  
Chart Review ◽  
Pediatric Patients ◽  
Demographic Data ◽  
Tertiary Care ◽  
Case Series ◽  
Late Failure ◽  
Final Study ◽  
Study Population ◽  
Tertiary Care Institution

Objective To determine the successful decannulation rate with a published pediatric tracheostomy decannulation protocol. Study Design Case series with chart review. Setting A single tertiary care institution. Subjects and Methods A chart review was performed for patients aged ≤5 years who underwent tracheostomy. Extracted data included demographic data, indication for tracheostomy, age at tracheostomy and decannulation, comorbidities, and surgical complications. Records were searched for documentation of early decannulation failure (within 1 month of decannulation) or late failure (within 1 year). Results Forty patients with a tracheostomy aged ≤5 years underwent attempted decannulation during the 11-year study period. Seventeen patients were excluded from the study for documentation of nonprotocol decannulation. The final study population of 23 patients underwent a total of 27 decannulations, 26 of which were performed by protocol. Of the 26 protocol decannulations, 22 were successful, for a failure rate of 15%. Conclusion Twenty-six protocol decannulations were attempted among 23 patients, 4 of which were unsuccessful for an overall failure rate of 15%. This result is consistent with rates reported in other published decannulation protocols. We believe that our protocol minimizes resource utilization in its use of pulse oximetry over polysomnography, while maximizing patient safety and success through the use of capping trials for very young and very small pediatric patients.

scholarly journals A Conscious Sedation Protocol for Videolaryngostroboscopy in Pediatric Patients

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Samantha Anne ◽  
Lawrence M. Borland ◽  
Laura Haibeck ◽  
Joseph E. Dohar
Keyword(s):  
Outcome Measures ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Treatment Plan ◽  
Tertiary Care ◽  
Case Series ◽  
Diagnostic Information ◽  
Secondary Outcome ◽  
Sedation Protocol

Objective. To determine best sedation protocol for videolaryngostroboscopy in children unable to tolerate non-sedated evaluation.Materials and Methods.Consecutive case series of 10 children with voice disturbances, unable to tolerate nonsedated videolaryngostroboscopy at an academic tertiary care children’s hospital. Flexible fiberoptic videolaryngostroboscopy was performed and interpreted by pediatric otolaryngologist and speech and language pathologist. Sedation was administered with newly described protocol that allowed functional portion of evaluation.Main Outcome Measures: ability to follow commands and tolerate flexible fiberoptic videolaryngostroboscopy.Secondary Outcome Measures: total phonation time, complications, need for subsequent videolaryngostroboscopic attempts, clinical outcomes, and follow-up.Results. 10 children underwent procedure under conscious sedation. 9/10 children were able to perform simple tasks and maintain adequate phonation time to complete stroboscopic exam. 1/10 patients failed to complete exam because of crying during entire exam. Mean exam time was 2 minutes 52 seconds (SD 86 seconds), phonation time is 1 minute 44 seconds (SD 60 seconds), and number of tasks completed was 10.5 (SD 8.6).Conclusions. Conscious sedation for videolaryngostroboscopy can be safely and effectively performed in children unable to comply with nonsedated examination. Such studies provide valuable diagnostic information to make a diagnosis and to devise a treatment plan.

scholarly journals Bilateral peritonsillar abscess: a case series

2019 ◽  
Vol 5 (3) ◽  
pp. 772
Author(s):  
Ng Chun Tau ◽  
Ahmad Nordin Afandi
Keyword(s):  
Medical Therapy ◽  
Complete Resolution ◽  
Case Series ◽  
Needle Aspiration ◽  
Peritonsillar Abscess ◽  
The Other ◽  
Incision And Drainage ◽  
Tomography Imaging ◽  
First Case ◽  
Intravenous Antibiotics

<p class="abstract">Peritonsillar abscess (PTA) is one of the most common deep neck abscesses. Unlike unilateral peritonsillar abscess, bilateral peritonsillar abscess is rather rare. We report 3 cases of bilateral peritonsillar abscess which were proven by either computerized tomography imaging or needle aspiration. One of the patients was treated with intravenous antibiotics and corticosteroid. The other 2 patients underwent needle aspiration for confirmation of diagnosis and subsequent incision and drainage. All patients were treated successfully with complete resolution. Bilateral PTA should always be considered when there is presence of bilateral peritonsillar swelling with non-deviated uvula and trismus. Despite surgical drainage being the most common management, the option of medical therapy alone may be sufficient. To the best of our knowledge, this is the first case of bilateral PTA reported being treated successfully with medical therapy.</p>

scholarly journals A Near Brush with Death: A Case Report on Oral Foreign Body Impalement

2019 ◽  
Vol 2 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Rachel Christner ◽  
Marisa Homer ◽  
Oliver Atar ◽  
Brian Hynes
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Foreign Body ◽  
Emergency Room ◽  
Operating Room ◽  
Pediatric Patient ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Upper Airway

We describe a case of an 11-month-old baby presenting to the emergency room with a foreign body in the upper airway. After unsuccessfully attempting to remove the foreign body in the emergency department, the otolaryngologist was consulted. The patient was taken to the operating room, and a comb was successfully removed under conscious sedation. This case illustrates the need of a well-considered strategy for managing the airway of a pediatric patient with a foreign body, while also demonstrating the unique challenges of treating pediatric patients.

scholarly journals P163: Methanol poisoning by inhalation: a case series

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S115-S115
Author(s):  
H. Yaworski ◽  
W. Palatnick ◽  
C. Oleschuk ◽  
S. Ringland ◽  
M. Tenebein
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Case Series ◽  
Methanol Intoxication ◽  
Methanol Poisoning ◽  
Product Formulation ◽  
Retail Outlets ◽  
Chief Complaints ◽  
Gastrointestinal Complaints ◽  
Ed Visits

Introduction: Methanol intoxication is a well-recognized toxicological emergency. While most cases of significant methanol poisoning occur via ingestion, there are reports in the literature of poisoning resulting from the inhalational route. We report a series of methanol intoxications secondary to inhalational abuse of a methanol containing lacquer thinner presenting to an inner city Emergency Department. Methods: A laboratory database was searched for methanol levels > 5 mmol/L. (16mg/dL). from January 1, 2010 to December 31, 2015. A chart review was completed to determine mode of poisoning, clinical presentation, treatment, and disposition. Results: We found 35 patients who made a total of 83 emergency department (ED) visits with a methanol level > 5mmol/L. (16mg/dL). The methanol levels ranged from 5.3-39.6 mmol/L. (16.96 -126.72 mg/dL) . 73% of poisonings were secondary to inhalation of a methanol-containing lacquer thinner. The median age of these patients was 43 years, and 49% were male. The majority of patients (96%) resided in the core area. The most frequent chief complaints were substance abuse/intoxication, gastrointestinal complaints, and chest pain. 18% of patients described visual symptoms. Treatments were fomepizole only (59%), fomepizole plus hemodialysis (26%), and hemodialysis alone (2%). 49% of patients were discharged from the ED, while 28% and 23% were admitted to an intensive care unit (ICU) and an internal medicine ward respectively. There were no cases of blindness. We describe a cohort of patients who developed methanol poisoning from inhalation of a methanol containing lacquer thinner that required treatment with fomepizole and hemodialysis. While almost 1/3 of these patients were admitted to ICU, 49% were discharged from the emergency department after a course of fomepizole. The etiology of this outbreak was found to be a change in the formulation of the lacquer thinner, substituting a higher concentration of methanol for toluene. The manufacturer and a number of local retail outlets were contacted. This resulted in the product being taken off the shelves by the retail outlets, and eventually, a change in the product formulation by the manufacturer, with a resultant decrease in the methanol content. After these actions, we have not seen any additional presentations of inhalational methanol intoxication. Conclusion: We report the largest case series to date of patients who presented with methanol intoxication, requiring fomepizole and/or hemodialysis, secondary to inhalation of a methanol containing lacquer thinner. Physician advocacy regarding the etiology of this outbreak resulted in collaboration with retail outlets and subsequent action by the manufacturer. This ended the outbreak.

Limited Flexor Sheath Incision and Drainage in the Emergency Department in the Management of Early Pyogenic Flexor Tenosynovitis

Hand ◽  
2021 ◽  
pp. 155894472199972
Author(s):  
Vinay Rao ◽  
William K. Snapp ◽  
Joseph W. Crozier ◽  
Reena A. Bhatt ◽  
Scott T. Schmidt ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Series ◽  
Definitive Treatment ◽  
Limited Data ◽  
Incision And Drainage ◽  
Safety And Efficacy ◽  
Functional Scores ◽  
Procedural Complications ◽  
Pyogenic Flexor Tenosynovitis ◽  
Flexor Tenosynovitis

Background Pyogenic flexor tenosynovitis (PFT) has been considered a surgical emergency. Varying operative approaches have been described, but there are limited data on the method, safety, and efficacy of nonoperative or bedside management. We present a case series where patients with early flexor tenosynovitis are managed using a limited flexor sheath incision and drainage (I&D) in the emergency department (ED) to both confirm purulence within the flexor sheath and as definitive treatment. Methods A retrospective study of all patients clinically diagnosed in the ED with flexor tenosynovitis at our institution from 2012 to 2019 was performed. Patients with frank purulence on examination were taken emergently to the operating room (OR). Patients with equivocal findings underwent limited flexor sheath I&D in the ED. Safety and efficacy were studied for patients with early flexor tenosynovitis managed with this treatment approach. Results Thirty-four patients met the inclusion criteria. Ten patients underwent direct OR I&D, and 24 patients underwent ED I&D. In the ED I&D group, 96% (24 of 25) of patients did not have frank purulence in the flexor sheath and were managed with bedside drainage alone. There were no procedural complications and no need for repeat operative intervention. Time to intervention (3.1 hours vs 8.4 hours) was significantly shorter for the ED I&D group compared with the OR I&D group. Within the ED I&D group, 86% of patients exhibited good/excellent functional scores. Conclusions Limited flexor sheath I&D in the ED provides a potential safe and effective way to manage patients with early flexor tenosynovitis.

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