Anesthetic And Surgical Efficacy And Safety In Combined Vs. Separate Palatoplasty And Myringotomy In Patients With Cleft Palate
Esperanza Mantilla, M.D1, Ishwarya Mamidi, B.S2, Alex Rokni, B.S2, Ashleigh Brennan, B.S2.
1Children's National Health System, Washington, DC, USA, 2Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
Background: Patients born with cleft lip and palate undergo multiple surgical procedures, increasing the infantile exposure to anesthesia and risk of neurocognitive delays. In addition, these numerous procedures lead to greater use of hospital resources. This study analyzes the differences in anesthetic exposure and perioperative characteristics between performing combined vs. separate primary palatoplasty (PP) and placement of bilateral myringotomy tubes (BMT).
Methods: We reviewed patients younger than 2 years of age who underwent PP and BMT at our institution from June 2014 to January 2019. Patients who underwent PP and BMT during the same admission (Combined Group or CG = 74) and separate admissions (Separate Group or SG = 15) were studied. Due to the small sample size in SG, additional data for this group was gathered by propensity score matching by gender, race and ASA class. Statistical analyses were carried out to identify significant differences between the two groups. Linear regression was performed to compare perioperative variables.
Results: Eighty-nine (89) patients met inclusion criteria. There were no significant differences in demographic characteristics or ASA class, surgery and anesthesia duration, dosage of intraoperative dexmedetomidine, hospital length of stay (LOS) and perioperative complications (p-value>0.05). Per contra, CG had significantly lower intraoperative dosages of fentanyl (p-value = 0.01) and shorter PACU stay (p-value=0.047).
Conclusion: This study documents decreased PACU time and anesthesia drug exposure without increased LOS or perioperative complications in patients undergoing combined PP and BMT. These results support combining PP and BMT to reduce exposure to potentially neurotoxic medications.
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