Lee Dong-Hee
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
J Audiol Otol. 2016 Dec;20(3):127-130. doi: 10.7874/jao.2016.20.3.127. Epub 2016 Nov 30.
The use of general (face-mask inhalation and intravenous) anesthesia has been the method of choice for tympanostomy tube insertion in children. However, there is no exact guideline for the choice of anesthesia method and there is no evidence to support the use of one anesthesia method over another. Clinically, the anesthesia method used to be decided by old customs and the surgeon's blind faith that children cannot bear tympanostomy tube insertion under local anesthesia. Clinicians should keep in mind that pediatric anesthesia has a potential risk. Despite infrequent serious complications, their seriousness necessitates that sedation or general anesthesia should be done by an anesthesiologist and thus children requiring tympanostomy tube insertion should be referred to secondary or tertiary hospitals, even if they have been followed by a primary care physician for a long time. Previous evidence showed that local anesthesia is appropriate for tympanostomy tube insertion in selected children, especially in children older than 5 years are older. Proper choice of anesthesia method is helpful for both patient and medical service provider. Local anesthesia can give psychological relief to children and their parent. It is easier for the medical service providers to schedule the operation and allocate the medical resources in their hospital. Local anesthesia can reduce individual, social, and national burdens for the health care services.
全身麻醉(面罩吸入麻醉和静脉麻醉)一直是儿童鼓膜置管术的首选麻醉方法。然而,对于麻醉方法的选择尚无确切的指南,也没有证据支持一种麻醉方法优于另一种。临床上,麻醉方法过去常由传统习俗以及外科医生盲目认为儿童无法耐受局部麻醉下的鼓膜置管术来决定。临床医生应牢记,小儿麻醉存在潜在风险。尽管严重并发症并不常见,但其严重性要求镇静或全身麻醉应由麻醉医生进行,因此,即使一些需要鼓膜置管术的儿童长期由初级保健医生随访,也应转诊至二级或三级医院。先前的证据表明,局部麻醉适用于特定儿童的鼓膜置管术,尤其是5岁及以上的儿童。正确选择麻醉方法对患者和医疗服务提供者都有帮助。局部麻醉可以减轻儿童及其家长的心理负担。对于医疗服务提供者来说,安排手术和在医院分配医疗资源更容易。局部麻醉可以减轻个人、社会和国家的医疗保健服务负担。