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Chapter: Clinical Anesthesiology: Anesthetic Management: Pediatric Anesthesia

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Anesthetic Considerations in Myringotomy & Insertion of Tympanostomy Tubes

Children presenting for myringotomy and inser-tion of tympanostomy tubes have a long history of URIs that have spread through the eustachian tube, causing repeated episodes of otitis media.

MYRINGOTOMY & INSERTION OF TYMPANOSTOMY TUBES

 

Pathophysiology

 

Children presenting for myringotomy and inser-tion of tympanostomy tubes have a long history of URIs that have spread through the eustachian tube, causing repeated episodes of otitis media. Causative organisms are usually bacterial and include Pneumococcus, H influenza, Streptococcus, and Mycoplasma pneumoniae. Myringotomy, a radial incision in the tympanic membrane, releases any fluid that has accumulated in the middle ear. Tympanostomy tubes provide long-term drainage. Because of the chronic and recurring nature of this illness, it is not surprising that these patients often have symptoms of a URI on the day of scheduled surgery.

 

Anesthetic Considerations

 

Th ese are typically very short (10–15 min) outpa-tient procedures. Inhalational induction is a com-mon technique. Unlike tympanoplasty surgery, nitrous oxide diffusion into the middle ear is not a problem during myringotomy because of the brief period of anesthetic exposure before the middle ear is vented. Because most of these patients are other-wise healthy and there is no blood loss, intravenous access is usually not necessary. Ventilation with a face mask or LMA minimizes the risk of periopera-tive respiratory complications (eg, laryngospasm) associated with intubation.

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