Anestesia e Pesquisa Clínica
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Randomized Comparison of Monitored Anesthesia Care and General Anesthesia Techniques in Patients Undergoing Sialendoscopies

Sucheta Kundu, Medha Mohta, PP Singh, Rajeev Kumar Malhotra and Mahendra Kumar

Background and aim: The choice of anesthetic technique for sialendoscopy is not clear due to lack of enough evidence. The present study aimed at comparing general anesthesia (GA) and monitored anesthesia care (MAC) for adult patients undergoing sialendoscopies.

Methods: This was a randomized, open-label, single center study. Sixty ASA I/II adult patients undergoing sialendoscopy received either GA with endotracheal intubation and oropharyngeal packing or MAC with midazolam, fentanyl and lignocaine infiltration of mucosa surrounding the papilla. The primary outcome was time to discharge readiness from recovery room; whereas secondary outcomes included hemodynamic changes, operating room (OR) times, perioperative complications, patient satisfaction and surgical difficulty scores. Statistical analysis was performed using Student ‘t’ test, Mann-Whitney U test, Chi-square test and Linear Mixed Model. P<0.05 was considered significant.

Results: The median (IQR[range]) time to discharge readiness was significantly shorter following MAC {0(0[0-30]) mins} as compared to GA {30(30[0-75]) min}; (p=0.000). The mean anesthesia, surgery and OR durations were also shorter under MAC. The patient satisfaction score appeared to be better with GA but this difference was statistically insignificant (p=0.052). The surgical difficulty level was significantly higher in group MAC (p=0.024). MAC resulted in more stable intraoperative hemodynamic parameters, lower postoperative pain scores and avoidance of complications associated with GA.

Conclusion: Selection of MAC for sialendoscopy hastens postoperative recovery, reduces perioperative complications and saves operating room time without significant difference in patient satisfaction.