Comparison of the Safety of Anesthetic Agents in Ambulatory Procedures for Pediatric Population in Oral and Maxillofacial Surgery
Statement of the Problem: Intravenous sedation during ambulatory oral and maxillofacial surgery procedures is often a necessary component in the practices of oral and maxillofacial surgeons (OMS). The purpose of the study was to compare the safety and anesthetic outcomes of propofol and methohexital in pediatric patients aged 20 years old or younger. Additionally, the study compared the safety and adverse effects of the two agents when administered by an OMS or a non-OMS provider.
Materials and Methods: A prospective study on patients undergoing ambulatory procedures throughout the United States from 2001-2010 was conducted to assess the safety of anesthetic techniques by OMS and non-OMS surgeons/anesthetists. The study variables included demographic information of the patients including age and gender, ASA physical status classification, anesthetic agents such as methohexital and propofol, duration of anesthesia, adverse outcomes related to anesthesia, operative procedures, and providers of anesthesia. These variables were compared with the patient group that received benzodiazepine/narcotics for sedation as a control group.
Methods of Data Analysis: For statistical analyses, stata/SE 11 (StataCorp., College Station, TX, USA) was used. Results were considered significant if p-values were less than 0.05. Both bivariate (Fisher’s exact test) and multivariate analyses (logistic regression) were conducted.
Results: The study included a total of 39,366 patients who met the inclusion criteria. Among all study subjects, 308 (1.04%) had an adverse event. Vomiting without aspiration was the most common complication with 91 events (0.27%), prolonged emergence from anesthesia was the second with 66 events (0.19%), followed by peripheral vascular injury with 47 adverse events (0.14%). Among the patients in the benzodiazepine, propofol, and methohexital group, the adverse outcome rates were 0.91%, 0.33%, and 1.2%, respectively. The complication rate in the methohexital group had a statistically significant difference in comparison to the other two groups (p=0.000). When comparing patients who received anesthesia from an OMS to those who received from a non-OMS personnel, there was also no statistically significant difference in adverse outcomes for multivariate analysis (p=0.017, bivariate analysis; p=0.46, multivariate analysis). When comparing patients in the methohexital group who received anesthesia from an OMS with those who received from a non-OMS personnel, there was no statistically significant difference in adverse outcomes (p=1.00, bivariate analysis; p=0.14, multivariate analysis).
Conclusions: A statistically significant increase in adverse events related to methohexital compared to propofol and benzodiazepine for anesthesia was observed in patients 20 years old or younger. Propofol showed the lowest risk for adverse events compared to methohexital and benzodiazepine. There was no statistically significant difference in the frequency of adverse outcomes for administration of methohexital between OMS and non-OMS surgeons/anesthetists.
References
Lee JS, Gonzalez ML, Chuang SK, Perrott DH.Comparison of methohexital and propofol use in ambulatory procedures in oral and maxillofacial surgery. J Oral Maxillofac Surg. 2008;66(10):1996-2003.
Perrott DH, Yuen JP, Andresen RV, et al: Office-based ambulatory anesthesia: Outcomes of clinical practice of oral and maxillofacial surgeons. J Oral MaxillofacSurg 61:983, 2003.