Trujillo Oscar, Drusin Madeleine A, Pagano Parwane P, Askin Gulce, Rahmati Rahmatullah
Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian/Columbia University Medical Center, New York, New York.
Department of Anesthesiology, Columbia University Medical Center, New York, New York.
JAMA Otolaryngol Head Neck Surg. 2017 Aug 1;143(8):769-774. doi: 10.1001/jamaoto.2017.0181.
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.
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.
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.
在美国，唾液腺内镜检查大多在全身麻醉下进行气管插管（GETA）；然而，监护麻醉（MAC）可能是一种可行的替代方案。
研究在MAC或GETA下进行唾液腺内镜检查后的患者特征和结果，以评估MAC作为替代麻醉选择的潜力。
设计、背景和参与者：对2011年10月1日至2014年8月31日期间接受唾液腺内镜检查的患者的病历进行回顾性分析。评估患者特征、涎石特征、术中发现、手术时间（OT）、麻醉时间（AT）和结果。数据分析于2015年11月1日至2016年3月1日进行。
MAC和GETA下唾液腺内镜检查的手术和麻醉时间。
65例患者接受了70次唾液腺内镜检查：27例在MAC下进行，43例在GETA下进行。总体而言，65例患者中有37例（56.9%）为女性，MAC组17例（63.0%），GETA组20例（52.6%）。MAC组和GETA组患者的平均（标准差）年龄分别为49.4（17.3）岁和47.2（16.2）岁。MAC病例中，无结石（49.0[31.0 - 49.0]）和有结石（41.0[28.0 - 92.0]）时的手术时间中位数（第25 - 75四分位数）分钟有显著差异；沃顿管（46.0[28.0 - 92.0]）和斯滕森管（37.0；1例）有结石时差异不显著。GETA病例中，无结石（55.0[52.0 - 91.0]）和有结石（77.0[56.0 - 107.0]）时也有显著差异；沃顿管（79.0[56.0 - 107.0]）和斯滕森管（65.0[49.0 - 98.0]）有结石时差异不显著。MAC病例中，无结石（33.0[30.0 - 39.0]）和有结石（38.0[32.0 - 55.0]）时的麻醉时间分钟有显著差异；沃顿管（60.0[32.0 - 55.0]）和斯滕森管（37.0；1例）有结石时差异不显著。GETA病例中，无结石（61.0[52.0 - 67.0]）和有结石（59.0[53.0 - 67.0]）时也有显著差异；沃顿管（60.0[54.0 - 69.0]）和斯滕森管（52.0[48.0 - 61.0]）有结石时差异不显著。
本研究表明，无论病例情况如何变化，如有无结石、结石清除是否成功、结石大小（>5mm）、结石位置以及唾液腺内镜辅助开放手术等，MAC下的唾液腺内镜检查手术时间和麻醉时间中位数更快。在有经验的外科医生、熟悉MAC管理的经验丰富的麻醉医生、结石较小（<4mm）且为单个结石的病例以及愿意在无GETA情况下接受手术的患者等合适的情况下，MAC下的唾液腺内镜检查可能是GETA的合理麻醉替代方案。
