[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.225.194.144. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Views 861
Citations 0
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.

×