Abstract | BACKGROUND: METHODS: All cases from one surgeon at a tertiary pediatric hospital were reviewed for patient age, anesthetic type, technical difficulties, and complications. RESULTS: From 12/2007 to 3/2013, 114 cases (49% implantations, 25% removals/re-implantations, 25% removals) were performed. Local anesthesia was employed in 100% of non- general anesthesia cases (n=109, 96%), augmented by inhaled N2O in 49%. Five patients (4%) underwent general anesthesia: three neurologically-impaired and two coordinated with scheduled MRIs. Procedural difficulties (n=18, 16%) included implant fracture during removal (n=16/58 removals, 28%). Fracture never occurred during implantation. Three children (3%) suffered complications. One infection was treated with antibiotics, and two implants were removed for systemic allergic reaction. Six children (5%) had unscheduled post-operative checks for pain (n=3, 3%), allergy to elastic dressing (n=2, 2%), or rash (n=1, 1%). Mean charges for general anesthesia were $10,188±1292 versus $528±147 for N2O or local alone (p<0.0001). CONCLUSION: While histrelin implantation is straightforward, removal presents technical challenges. Local anesthesia, with possible N2O supplementation, is well-tolerated and introduces substantial resource and cost savings.
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Authors | James S Davis, Fuad Alkhoury, Cathy Burnweit |
Journal | Journal of pediatric surgery
(J Pediatr Surg)
Vol. 49
Issue 5
Pg. 807-10
(May 2014)
ISSN: 1531-5037 [Electronic] United States |
PMID | 24851775
(Publication Type: Journal Article)
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Copyright | Copyright © 2014 Elsevier Inc. All rights reserved. |
Chemical References |
- Anesthetics, Inhalation
- Capsules
- Drug Implants
- Gonadotropin-Releasing Hormone
- histrelin
- Nitrous Oxide
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Topics |
- Anesthesia, General
- Anesthesia, Local
- Anesthetics, Inhalation
(administration & dosage)
- Capsules
- Child
- Conscious Sedation
(methods)
- Cost Savings
- Device Removal
- Drug Implants
(administration & dosage, adverse effects, economics)
- Equipment Failure
- Female
- Gonadotropin-Releasing Hormone
(administration & dosage, analogs & derivatives)
- Humans
- Hypersensitivity
(etiology)
- Infections
(etiology)
- Male
- Nitrous Oxide
(administration & dosage)
- Puberty, Precocious
(drug therapy)
- Retrospective Studies
- Risk Factors
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