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Anesthetic Complications of Tympanostomy Tube Placement in Children.

Hoffmann KK, Thompson GK, Burke BL et al. Arch Otolaryngol Head Neck Surg. 128:1040-1043, 2002

The authors of this article reviewed the medical records of 3,198 children undergoing bilateral myringotomy and tympanostomy tube, placement (BMTT) 1,000 of the charts were reviewed prospectively, the rest were reviewed retrospectively. No patients were excluded.

The ASA, age and concurrent or chronic medical conditions of the patient was noted. In addition, the level of the anesthesia staff, anesthetic technique, perioperative adverse event and treatment of such events was recorded. Major events included laryngospasm, bradycardia, stridor, oxygen desaturation greater than 10% of baseline, or dysrhythmia and occurred in 1.9% of patients. Minor adverse events included upper airway obstruction, prolonged recovery (> than 30 minutes) emesis and persistent agitation. Minor events occurred in 9% and in > 31% were attributable to agitation or prolonged recovery. The incidence of adverse events was unrelated to ASA, age, type of anesthetic provider or type of anesthetic.

However, the presence of an acute or chronic pre-existing medical condition increased the incidence of an adverse event by 2.78.

Comments: This is a nicely done study that confirms the low anesthetic risk of patients undergoing BMTT. AS with many other procedures the presence of pre-existing disease increases the incidence of complications.

Reviewed by: Rita Agarwal MD, FAAP
Denver, CO

Table of Contents

• Editor's Corner
• President's Message
• Society for Pediatric Anesthesia Policy Statment on Provision of Pediatric Anesthesia Care
• Williams Syndrome, Supravalvar Aortic Stenosis and Cardiac Arrest During Anesthesia
• Book Corner
• Out of Africa
• Peds Passport
• MHAUS Research Opportunities
• For Patients: Frequently Asked Questions


• Reviews & Commentary
  • Bariatric surgery for severely overweight adolescents: concerns and recommendations.
    Inge T, et al. Pediatrics 2004;114;217-223
  • Conscious sedation of children with propofol is anything but conscious
    Reeves ST, Havidich JE, and Tobin DP. Pediatrics 2004;114:e74-e76. URL http://www.pediatrics.org/cgi/content/ full/114/1/e74
  • A factorial trial of six interventions for the prevention of postoperative nausea and vomiting.
    Apfel CC, et al. N Engl J Med 2004; 50:2441-2451
  • The effect of dexrazoxane of myocardial injury in dozorubicin-treated children with acute lymphoblastic leukemia
    Lipshultz SE, et al. N Engl J Med 2004; 351:145-153
  • Unilateral negative-pressure pulmonary edema in an infant during bronchoscopy
    Shai Hannania, MD, et al. Pediatrics 2004;113:e501-e503. URL: http://www.pediatrics.org/cgi/content/full/113/5/e501
  • Does pediatric surgical specialty training affect outcome after Ramstedt Pyloromyotomy? A population-based study.
    Langer J, To T. Pediatrics 2004;113:1342-1347
  • Overweight children and adolescents; A risk group for iron deficiency
    Nead KG, et al. Pediatrics 2004;114:104-108
  • A comparison of conservative and aggressive transfusion regimens in the perioperative management of sickle cell disease
    Elliot P. Vichinsky, MD, et al and the Preoperative Transfusion in Sickle Cell Disease Study Group
  • Cholecystectomy in sickle cell anemia patients: Perioperative outcome of 364 cases from the National Preoperative Transfusion Study
    Charles M. Haberkern, et al, and the Preoperative Transfusion in Sickle Cell Disease Study Group
  • Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia
    Samuel Charache, MD, et al
  • Epidural Analgesia in the Management of Severe Vaso-Occlusive Sickle-Cell Crisis.
    Yaster M, et al. Pediatrics 1994;93:310-315


• Literature Reviews
  • A case of propofol toxicity: further evidence for a causal mechanism
    Davinia E Withington, Mary K. Decell, Tareq Al Ayed. Pediatric Anesthesia 2004;14:505
    Death after re-exposure to propofol in a 3-year-old child: a case report
    Josef Holzki, Christoph Aring, Alex Gillor. Paediatric Anaesthesia 2004;14:265
  • Does anaesthesia harm the developing brain - evidence or speculation?
    Andrew Davidson and Sulpicio Soriano. Paediatric Anaesthesia 2004; 14: 199-20.
  • An evaluation of pediatric in-hospital advanced life support interventions using the pediatric Utstein guidelines: a review of 203 cardiorespiratory arrests.
    J. Guay, L. Lortie.Can J Anesth 2004:51:4:373-378
  • A factorial trial of six interventions for the prevention of postoperative nausea and vomiting
    Christian C. Apfel, MD, et al. IMPACT Investigators. N Engl J Med 2004;350:2441-51
  • Interactive Music Therapy as a Treatment for Preoperative Anxiety in Children: A Randomized Controlled Trial
    Kain Z, Caldwell-Andrews A, Krivutza D, Weinberg M, Gaal D, Wang SM, Mayes L. Anesthesia & Analgesia 2004;98:1260-1266.
  • Trends in the practice of parental presence during induction of anesthesia and the use of preoperative sedative premedication in the United States, 1995-2002: results of a follow-up national survey.
    Kain, Z.N. et al. Anesth Analg 2004; 98:1252-9.
  • Anesthetic Complications of Tympanostomy Tube Placement in Children.
    Hoffmann KK, Thompson GK, Burke BL et al. Arch Otolaryngol Head Neck Surg. 128:1040-1043, 2002
  • Neurobehavioral Implications of Habitual Snoring in Children.
    O'Brien CM, et al. Pediatrics 2004; 116:44-50

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