Ghantous Jameel, Heiman Eyal, Zelman Ady, Hadar Ayalon, Schwarz Yehuda, Attal Pierre, Sichel Jean-Yves, Shaul Chanan
Department of Otolaryngology and Head and Neck Surgery, Shaare-Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel.
Pediatric Emergency Department, Shaare-Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel.
Int J Pediatr Otorhinolaryngol. 2024 Aug;183:112032. doi: 10.1016/j.ijporl.2024.112032. Epub 2024 Jul 14.
Peritonsillar abscess (PTA) is a common pediatric infection requiring drainage. Conscious Sedation (CS) can facilitate drainage in uncooperative children. However, it carries risks, especially if the airway is compromised. Moreover, evidence on its safety and efficacy is limited. This study examined the safety, pain reduction, and anxiety management of hospitalized pediatric patients treated for PTA under CS.
We performed a prospective observational case series of 118 children aged 2-15 years with 155 PTA episodes, managed from 2016 to 2023. Conscious sedation was used in 42 episodes. Outcomes were compared among CS and non-CS (local anesthesia only). Complications assessed safety. Efficacy was evaluated by the amount of pus, hospitalization parameters, pain scores, and recurrence.
No significant differences were found regarding the demographic and presentation parameters except for younger age among the CS group (9 vs 11 years p = 0.001). One minor oxygen desaturation (2 %) event occurred with CS. Abscess drainage amount was greater with CS than non-CS, 4.9±4 mL vs. 3.2±2 mL, respectively (p = 0.03). Hospitalization stays were similar among groups. Maximum pain scores were lower with CS than non-CS, 1.4 ± 2 vs 4.2 ± 3 (p < 0.001); similarly, IV pain medication was used less frequently, 0.9 ± 1 vs. 1.6 ± 3 (p = 0.045), and the need for re-aspiration was less common 14 % vs. 28 % (p = 0.04), with CS than non-CS, respectively. The three-month recurrence rate was numerically lower with CS (5 % vs. 14 % non-CS).
Conscious sedation facilitates PTA drainage with excellent safety and improved efficacy compared to local anesthesia in children. Pain scores are reduced both during drainage and hospitalization. Our prospective data add to the limited evidence supporting CS as a viable option for abscess drainage in uncooperative pediatric patients. Further study is warranted to confirm potential long-term reductions in recurrence.
扁桃体周围脓肿（PTA）是一种常见的儿科感染，需要进行引流。清醒镇静（CS）可促进不配合儿童的引流。然而，它存在风险，尤其是在气道受影响的情况下。此外，关于其安全性和有效性的证据有限。本研究探讨了在CS下接受PTA治疗的住院儿科患者的安全性、疼痛减轻情况及焦虑管理。
我们对2016年至2023年期间收治的118例2至15岁患有155次PTA发作的儿童进行了一项前瞻性观察病例系列研究。其中42次发作使用了清醒镇静。对CS组和非CS组（仅局部麻醉）的结果进行了比较。通过并发症评估安全性。通过脓液量、住院参数、疼痛评分和复发情况评估有效性。
除CS组年龄较小外（9岁对11岁，p = 0.001），在人口统计学和临床表现参数方面未发现显著差异。CS组发生了1次轻微的氧饱和度下降（2%）事件。CS组的脓肿引流量大于非CS组，分别为4.9±4 mL对3.2±2 mL（p = 0.03）。各组的住院时间相似。CS组的最大疼痛评分低于非CS组，分别为1.4±2对4.2±3（p < 0.001）；同样，CS组使用静脉镇痛药物的频率较低，分别为0.9±1对1.6±3（p = 0.045），且CS组再次抽吸的需求比非CS组少见，分别为14%对28%（p = 0.04）。CS组的三个月复发率在数值上低于非CS组（5%对14%）。
与局部麻醉相比，清醒镇静在儿童中促进PTA引流具有出色的安全性和更高的有效性。在引流和住院期间疼痛评分均降低。我们的前瞻性数据补充了有限的证据，支持CS作为不配合儿科患者脓肿引流的可行选择。有必要进行进一步研究以确认复发率是否可能长期降低。
