Difference between revisions of "Myringotomy for ear tubes"
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|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 | |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 | ||
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Revision as of 21:44, 21 February 2022
| 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 |
Laryngospasm |
| 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 |
|---|---|
| Pulmonary | 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 without 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)
Top contributors: Cornel Chiu, Elena Brandford and Chris Rishel