Difference between revisions of "Myringotomy for ear tubes"
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| considerations_preoperative = Assessment of upper respiratory infection | | considerations_preoperative = Assessment of upper respiratory infection | ||
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| considerations_postoperative = Laryngospasm | | considerations_postoperative = Laryngospasm, PONV, emergence delirium | ||
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Myringotomy is a commonly performed procedure in pediatrics. The procedure involves placement of tubes within the middle ear to provide better drainage decreasing the risk of otitis media. Indication for the procedure includes recurrent otitis media episodes of six or more in one year, chronic serous otitis media, eustachian tube dysfunction and hearing loss <ref>{{Cite book|url=https://www.worldcat.org/oclc/1117874404|title=Anesthesiologist's manual of surgical procedures|date=2020|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu|isbn=978-1-4698-2916-6|edition=Sixth edition|location=Philadelphia|oclc=1117874404}}</ref>. The procedure begins with an incision of the tympanic membrane. A tympanostomy tube is placed within the incision allowing for equalization of pressure and drainage of fluid in the middle ear. | Myringotomy is a commonly performed procedure in pediatrics. The procedure involves placement of tubes within the middle ear to provide better drainage decreasing the risk of otitis media. Indication for the procedure includes recurrent otitis media episodes of six or more in one year, chronic serous otitis media, eustachian tube dysfunction and hearing loss <ref>{{Cite book|url=https://www.worldcat.org/oclc/1117874404|title=Anesthesiologist's manual of surgical procedures|date=2020|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu|isbn=978-1-4698-2916-6|edition=Sixth edition|location=Philadelphia|oclc=1117874404}}</ref>. The procedure begins with an incision of the tympanic membrane. A tympanostomy tube is placed within the incision allowing for equalization of pressure and drainage of fluid in the middle ear<ref>{{Cite journal|last=Robinson|first=Hal|last2=Engelhardt|first2=Thomas|date=2017-04-19|title=Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives|url=https://www.dovepress.com/ambulatory-anesthetic-care-in-children-undergoing-myringotomy-and-tube-peer-reviewed-fulltext-article-LRA|journal=Local and Regional Anesthesia|language=English|volume=10|pages=41–49|doi=10.2147/LRA.S113591|pmc=PMC5403003|pmid=28458577}}</ref>. | ||
== Preoperative management == | == Preoperative management == | ||
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* Mask induction with sevoflurane +/- N<sub>2</sub>O | * Mask induction with sevoflurane +/- N<sub>2</sub>O | ||
* Anesthesia mask | * Anesthesia mask kept on for the duration of the procedure | ||
* LMA | * LMA | ||
* ETT rarely indicated (laryngospasm) | * ETT rarely indicated (laryngospasm) | ||
| Line 52: | Line 52: | ||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ||
* Maintained on volatile anesthetic | * Maintained on volatile anesthetic supplemented with analgesia | ||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
* Emergence delirium | * PONV prophylaxis | ||
* Emergence delirium | |||
== Postoperative management == | == Postoperative management == | ||
| Line 67: | Line 68: | ||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | === Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | ||
* Minimal post-operative pain | * Minimal post-operative pain, preferably avoiding longer acting opioids | ||
* Multimodal analgesia | * Multimodal analgesia | ||
| Line 75: | Line 76: | ||
*** IM/IN fentanyl | *** IM/IN fentanyl | ||
** If PIV | ** If PIV | ||
*** PO/IV acetaminophen | *** PO/IV acetaminophen | ||
*** IV ketoralac | *** IV ketoralac | ||
*** IV fentanyl | *** IV fentanyl | ||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
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|- | |- | ||
|Unique considerations | |Unique considerations | ||
| | |Can be performed with IV access | ||
|- | |- | ||
|Position | |Position | ||
Revision as of 09:30, 18 January 2022
Myringotomy for ear tubes
| Anesthesia type |
General |
|---|---|
| Airway |
Anesthesia mask vs LMA vs ETT |
| Lines and access |
No access vs PIV x 1 |
| Monitors |
Standard ASA monitors |
| Primary anesthetic considerations | |
| Preoperative |
Assessment of upper respiratory infection |
| Intraoperative | |
| Postoperative |
Laryngospasm, PONV, emergence delirium |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Myringotomy is a commonly performed procedure in pediatrics. The procedure involves placement of tubes within the middle ear to provide better drainage decreasing the risk of otitis media. Indication for the procedure includes recurrent otitis media episodes of six or more in one year, chronic serous otitis media, eustachian tube dysfunction and hearing loss [1]. The procedure begins with an incision of the tympanic membrane. A tympanostomy tube is placed within the incision allowing for equalization of pressure and drainage of fluid in the middle ear[2].
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Respiratory | Assess for upper respiratory infection(URI), often patients have brief intervals between URI, if febrile illness is due to otitis media, may proceed with anesthesia. However, if febrile illness with lower respiratory tract infection, patient should not proceed with anesthesia |
| Other | Assess for conductive hearing loss |
Patient preparation and premedication
- PO midazolam for anxiety
- IN dexetomidine for anxiety and emergence delirium
- PO acetaminophen for pain
Intraoperative management
Monitoring and access
- Standard ASA monitors
- No access may be needed vs PIV x 1
Induction and airway management
- Mask induction with sevoflurane +/- N2O
- Anesthesia mask kept on for the duration of the procedure
- LMA
- ETT rarely indicated (laryngospasm)
Positioning
- Supine with head turned away from surgical site
Maintenance and surgical considerations
- Maintained on volatile anesthetic supplemented with analgesia
Emergence
- PONV prophylaxis
- Emergence delirium
Postoperative management
Disposition
- PACU
- Most cases discharged home
Pain management
- Minimal post-operative pain, preferably avoiding longer acting opioids
- Multimodal analgesia
- If no PIV:
- PO/PR acetaminophen
- IM ketoralac
- IM/IN fentanyl
- If PIV
- PO/IV acetaminophen
- IV ketoralac
- IV fentanyl
- If no PIV:
Potential complications
- Laryngospasm
Procedure variants
| Myringotomy | |
|---|---|
| Unique considerations | Can be performed with IV access |
| Position | Supine |
| Surgical time | 5-10 minutes |
| EBL | Minimal |
| Postoperative disposition | Home |
| Pain management | Mild, multimodal |
| Potential complications | Laryngospasm |
References
- ↑ Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (Sixth edition ed.). Philadelphia. 2020. ISBN 978-1-4698-2916-6. OCLC 1117874404.
|edition=has extra text (help)CS1 maint: others (link) - ↑ Robinson, Hal; Engelhardt, Thomas (2017-04-19). "Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives". Local and Regional Anesthesia. 10: 41–49. doi:10.2147/LRA.S113591. PMC 5403003. PMID 28458577.CS1 maint: PMC format (link)
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