Parental Satisfaction With Anesthesia Without Intravenous Access for Myringotomy

Abstract

Objective To evaluate the effect of intravenous (IV) 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 IV 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 µg/kg intramuscularly. Children with IV 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 ad-ministered by a pediatric anesthesiologist and a trainee. Results The groups were similar in age, weight, and incidence of vomiting. Children with IV 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 IV 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 IV access.