Conscious sedation: A new approach for peritonsillar abscess drainage in the pediatric population

Objective: To assess the safety and efficacy of conscious sedation (CS) in children undergoing emergency department incision and drainage (I and D) of peritonsillar abscesses (PTAs). Design: A 33-month retrospective chart review of all children presenting to the emergency department with the diagnosis of a PTA or peritonsillar cellulitis. Children who underwent CS prior to I and D were compared with children without CS for complications and efficacy. Setting: St Louis Children's Hospital, an academic tertiary care pediatric hospital. Patients: Fifty-two children were enrolled; 30 PTAs were drained with CS in 27 children (3 underwent I and D twice), and 25 PTAs were drained in 25 children without CS. Interventions: The CS team included an otolaryngologist, a pediatric emergency department physician, and a registered nurse. A standardized CS protocol assessing vital signs and level of consciousness was employed during each procedure. A combination of midazolam, ketamine hydrochloride, and glycopyrrolate was used in appropriately weighted calculated doses. Patients were assessed for major and minor airway complications. Main Outcome Measures: Airway complications related to CS were reviewed. Patients who underwent I and D with and without CS were compared with regard to purulent drainage. Results: There were no major airway complications in patients undergoing I and D with CS. There was 1 minor complication in this group, oxygen desaturation to 88%, which resolved with stimulation. Of the 55 procedures, 45 (82%) yielded purulence: 29 (97%) of 30 in the CS group and 16 (64%) of 25 in the non-CS group (χ² = 9.8; P = 002). Of those children undergoing CS, 3 (10%) of 30 were admitted to the hospital from the emergency department as compared with 6 (24%) of 25 without CS (χ² = 1.95; P = .16). In the CS group, PTAs had a low recurrence rate of 1 (3.3%) of 30 compared with 2 (8%) of 25 in the non-CS group (χ² = 0.57; P = .45). No one in the CS group required a secondary procedure under general anesthesia. Conclusions: This preliminary study demonstrates CS to be a potentially safe and efficacious approach to drainage of PTAs in children. Given its efficacy and its associated lower levels of anxiety and pain for the patient, CS seems to be a promising new approach to caring for children with PTAs.