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Trujillo O, Drusin MA, Pagano PP, Askin G, Rahmati R. Evaluation of Monitored Anesthesia Care in Sialendoscopy. JAMA Otolaryngol Head Neck Surg. 2017;143(8):769–774. doi:10.1001/jamaoto.2017.0181
Can monitored anesthesia care be offered as an effective alternative to general endotracheal anesthesia for salivary sialendoscopy procedures?
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.
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.
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.
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.
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.
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