Evaluation of Monitored Anesthesia Care in Sialendoscopy | Anesthesiology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.207.108.182. Please contact the publisher to request reinstatement.
[Skip to Navigation Landing]
1.
Huoh  KC, Eisele  DW.  Etiologic factors in sialolithiasis.  Otolaryngol Head Neck Surg. 2011;145(6):935-939.PubMedGoogle ScholarCrossref
2.
Lustmann  J, Regev  E, Melamed  Y.  Sialolithiasis: a survey on 245 patients and a review of the literature.  Int J Oral Maxillofac Surg. 1990;19(3):135-138.PubMedGoogle ScholarCrossref
3.
Makdissi  J, Escudier  MP, Brown  JE, Osailan  S, Drage  N, McGurk  M.  Glandular function after intraoral removal of salivary calculi from the hilum of the submandibular gland.  Br J Oral Maxillofac Surg. 2004;42(6):538-541.PubMedGoogle ScholarCrossref
4.
Nahlieli  O, Neder  A, Baruchin  AM.  Salivary gland endoscopy: a new technique for diagnosis and treatment of sialolithiasis.  J Oral Maxillofac Surg. 1994;52(12):1240-1242.PubMedGoogle ScholarCrossref
5.
Nahlieli  O, Nakar  LH, Nazarian  Y, Turner  MD.  Sialoendoscopy: a new approach to salivary gland obstructive pathology.  J Am Dent Assoc. 2006;137(10):1394-1400.PubMedGoogle ScholarCrossref
6.
Sá Rêgo  MM, Watcha  MF, White  PF.  The changing role of monitored anesthesia care in the ambulatory setting.  Anesth Analg. 1997;85(5):1020-1036.PubMedGoogle ScholarCrossref
7.
 2017 Relative Value Guide. Washington DC: American Society of Anesthesiologists; 2017.
8.
Marchal  F, Dulguerov  P.  Sialolithiasis management: the state of the art.  Arch Otolaryngol Head Neck Surg. 2003;129(9):951-956.PubMedGoogle ScholarCrossref
9.
Bitar  G, Mullis  W, Jacobs  W,  et al.  Safety and efficacy of office-based surgery with monitored anesthesia care/sedation in 4778 consecutive plastic surgery procedures.  Plast Reconstr Surg. 2003;111(1):150-156.PubMedGoogle ScholarCrossref
10.
Maresh  A, Kutler  DI, Kacker  A.  Sialoendoscopy in the diagnosis and management of obstructive sialadenitis.  Laryngoscope. 2011;121(3):495-500.PubMedGoogle ScholarCrossref
11.
Nahlieli  O, Baruchin  AM.  Long-term experience with endoscopic diagnosis and treatment of salivary gland inflammatory diseases.  Laryngoscope. 2000;110(6):988-993.PubMedGoogle ScholarCrossref
12.
Papadaki  ME, McCain  JP, Kim  K, Katz  RL, Kaban  LB, Troulis  MJ.  Interventional sialoendoscopy: early clinical results.  J Oral Maxillofac Surg. 2008;66(5):954-962.PubMedGoogle ScholarCrossref
13.
Ziegler  CM, Steveling  H, Seubert  M, Mühling  J.  Endoscopy: a minimally invasive procedure for diagnosis and treatment of diseases of the salivary glands. Six years of practical experience.  Br J Oral Maxillofac Surg. 2004;42(1):1-7.PubMedGoogle ScholarCrossref
14.
Chu  DW, Chow  TL, Lim  BH, Kwok  SP.  Endoscopic management of submandibular sialolithiasis.  Surg Endosc. 2003;17(6):876-879.PubMedGoogle ScholarCrossref
15.
Lari  N, Chossegros  C, Thiery  G, Guyot  L, Blanc  JL, Marchal  F.  Sialendoscopy of the salivary glands [in French].  Rev Stomatol Chir Maxillofac. 2008;109(3):167-171.PubMedGoogle ScholarCrossref
16.
Liu  DG, Zhang  ZY, Zhang  L, Zhang  Y, Song  XX, Yu  GY.  Endoscopic management of sialolithiasis (a practical experience in 52 cases) [in Chinese].  Zhonghua Kou Qiang Yi Xue Za Zhi. 2008;43(4):248-249.PubMedGoogle Scholar
17.
Yu  CQ, Yang  C, Zheng  LY, Wu  DM, Zhang  J, Yun  B.  Selective management of obstructive submandibular sialadenitis.  Br J Oral Maxillofac Surg. 2008;46(1):46-49.PubMedGoogle ScholarCrossref
18.
Rahmati  R, Gillespie  MB, Eisele  DW.  Is sialendoscopy an effective treatment for obstructive salivary gland disease?  Laryngoscope. 2013;123(8):1828-1829.PubMedGoogle ScholarCrossref
Original Investigation
August 2017

Evaluation of Monitored Anesthesia Care in Sialendoscopy

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, New York Presbyterian/Columbia University Medical Center, New York, New York
  • 2Department of Anesthesiology, Columbia University Medical Center, New York, New York
JAMA Otolaryngol Head Neck Surg. 2017;143(8):769-774. doi:10.1001/jamaoto.2017.0181
Key Points

Question  Can monitored anesthesia care be offered as an effective alternative to general endotracheal anesthesia for salivary sialendoscopy procedures?

Findings  In this retrospective review of medical records of 65 patients, sialendoscopy under MAC had faster median operative and anesthesia times, regardless of varying case circumstances. These circumstances included presence or lack of stones, successful stone removal, stone size (>5 mm), stone location, and sialendoscopy-assisted open procedures.

Meaning  Monitored anesthesia care may have a role as an alternative to general endotracheal anesthesia for sialendoscopy in the right circumstances with patients comfortable having the procedure performed under monitored anesthesia care.

Abstract

Importance  In the United States, sialendoscopy is most often performed under general anesthesia with endotracheal intubation (GETA); however, monitored anesthesia care (MAC) may be a viable alternative.

Objective  To investigate patient characteristics and outcomes following sialendoscopy performed under MAC or GETA to assess the potential of MAC as an alternative anesthetic option.

Design, Setting, and Participants  A retrospective review of medical records on patients who underwent sialendoscopy between October 1, 2011, and August 31, 2014, was performed. Patient characteristics, salivary stone characteristics, intraoperative findings, operative time (OT), anesthesia time (AT), and outcomes were evaluated. Data analysis was performed from November 1, 2015, to March 1, 2016.

Main Outcomes and Measures  Operative and anesthetic times for sialendoscopy under MAC and GETA.

Results  Sixty-five patients underwent 70 sialendoscopy procedures: 27 performed under MAC, 43 under GETA. Overall, 37 of 65 (56.9%) patients were women, with 17 (63.0%) in the MAC group and 20 (52.6%) in the GETA group. Mean (SD) patient age was 49.4 (17.3) and 47.2 (16.2) years for the MAC and GETA cohorts, respectively. Median (25th-75th quartiles) OT in minutes for MAC cases was significant for no stones (49.0 [31.0-49.0]) and stones (41.0 [28.0-92.0]) present; nonsignificant findings were stones in the Wharton (46.0 [28.0-92.0]) and Stenson (37.0; 1 case) ducts. For GETA cases, significance was also demonstrated for no stones (55.0 [52.0-91.0]) and stones (77.0 [56.0-107.0]) present; nonsignificant findings were stones in the Wharton (79.0 [56.0-107.0]) and Stenson (65.0 [49.0-98.0]) ducts. The AT in minutes for MAC cases was significant for no stones (33.0 [30.0-39.0]) and stones (38.0 [32.0-55.0]) present; nonsignificant findings were stones in the Wharton (60.0 [32.0-55.0]) and Stenson (37.0; 1 case) ducts. For GETA cases, findings were also significant for no stones (61.0 [52.0-67.0]) and stones (59.0 [53.0-67.0]) present; nonsignificant findings were stones in the Wharton (60.0 [54.0-69.0]) and Stenson (52.0 [48.0-61.0]) ducts.

Conclusions and Relevance  This study suggests that sialendoscopy under MAC has faster median OT and AT, regardless of varying case circumstances, such as the presence or lack of stones, successful stone removal, stone size (>5 mm), stone location, and sialendoscopy-assisted open procedures. Sialendoscopy under MAC may be a reasonable anesthetic alternative to GETA in an appropriate setting with an experienced surgeon, experienced anesthesiologist comfortable with administering MAC, cases with small (<4-mm) singular stones, and patients comfortable with undergoing the procedure without GETA.

×