Parental satisfaction with anesthesia without intravenous access for myringotomy

Abstract

Objective: To evaluate the effect of intravenous (i.v.) access in children undergoing bilateral myringotomy with pressure-equalizing tube placement.

Design: One hundred healthy children were enrolled in this randomized controlled study. One group received i.v. access; the other group did not. Anesthesia in both groups was induced through a mask and maintained with oxygen, nitrous oxide, and sevoflurane. Spontaneous ventilation was maintained. All children received fentanyl, 1 microg/kg intramuscularly. Children with i.v. access received 20 mL/kg of lactated Ringer's solution. Parents were telephoned the day after surgery to report on pain and vomiting, as well as their satisfaction with anesthesia.

Setting: Tertiary care children's hospital with all procedures performed by attending pediatric otolaryngologists and otolaryngology residents. Anesthesia was administered by a pediatric anesthesiologist and a trainee.

Results: The groups were similar in age, weight, and incidence of vomiting. Children with i.v. access spent more time than those without (mean +/- SD minutes) in the operating room (21 +/- 8 vs 17 +/- 7; P =.02), in phase 2 recovery (75 +/- 67 vs 51 +/- 24; P =.02), and in the hospital (119 +/- 67 vs 88 +/- 30; P =.005). These children also required more pain medication (31% vs 2%; P<.001) and had a lower parental satisfaction rate (28% vs 95%; P<.001).

Conclusions: Intravenous access in otherwise healthy children undergoing myringotomy provided no added benefit. Children without i.v. access had reduced pain requirement and spent less time in the operating room, in phase 2 recovery, and in the hospital. Parental satisfaction, a clinically relevant outcome, was significantly greater for parents of children without i.v. access.