Local anesthesia as an alternative to general anesthesia in ENT surgery – a review of selected procedures
DOI:
https://doi.org/10.12775/QS.2024.17.53354Keywords
anesthesia, otolaryngology, general anesthesia, local anesthesia, tonsillectomy, adenoidectomy, tympanostomy, myringotomy, flexible endoscopyAbstract
Surgeries and procedures in otolaryngology require close collaboration between anesthesiologists and ENT specialists, especially for operations involving the larynx and airways, which pose challenges for maintaining airway patency and visibility. Choosing the type of anesthesia, whether general or local, is crucial. This study examines the benefits and drawbacks of both types of anesthesia in tonsillectomy and adenoidectomy, tympanostomy and myringotomy, and flexible endoscopic biopsy of the pharynx and larynx. A review of current guidelines, systematic reviews and relevant clinical cohort studies was conducted. The findings highlight several advantages of local anesthesia, including shorter operation times, reduced hospital stays, lower costs, decreased use of analgesics, and improved patient comfort.
References
Cherian, V. T., & Vaida, S. J. (2019). Airway management in laryngeal surgery. Operative Techniques in Otolaryngology-Head and Neck Surgery, 30(4), 249–254. https://doi.org/10.1016/J.OTOT.2019.09.005
Koroulakis, A., & Agarwal, M. (2024). Laryngeal Cancer. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK526076/
Rivera, G. A., & Morell, F. (2023). Laryngeal Papillomas. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK562327/
Gurău, P., Sencu, E., & Vetricean, S. (2023). Flexible Endoscopic Surgery for Benign Nonepithelial Lesions of the Larynx. Indian Journal of Otolaryngology and Head & Neck Surgery, 75(2), 732. https://doi.org/10.1007/S12070-022-03444-Z
Randall, D. A. (2020). Current Indications for Tonsillectomy and Adenoidectomy. The Journal of the American Board of Family Medicine, 33(6), 1025–1030. https://doi.org/10.3122/JABFM.2020.06.200038
Hsu, J., & Tan, M. (2017). Anesthesia considerations in laryngeal surgery. International Anesthesiology Clinics, 55(1), 11–32. https://doi.org/10.1097/AIA.0000000000000126
Chu, E. A., & Kim, Y. J. (2008). Laryngeal Cancer: Diagnosis and Preoperative Work-up. Otolaryngologic Clinics of North America, 41(4), 673–695. https://doi.org/10.1016/J.OTC.2008.01.016
Stutz, E. W., & Rondeau, B. (2023). Mallampati Score. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK585119/
Cherian, V. T., & Vaida, S. J. (2019). Airway management in laryngeal surgery. Operative Techniques in Otolaryngology-Head and Neck Surgery, 30(4), 249–254. https://doi.org/10.1016/J.OTOT.2019.09.005
Balmert, N. J., & Duren, D. (2023). Anesthesia for Laryngeal Surgery. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK572099/
Wu, X., Shan, C., Peng, B., Shi, X., Zhang, F., & Cao, J. (2019). Comparison of desflurane and sevoflurane on postoperative recovery quality after tonsillectomy and adenoidectomy in children. Experimental and Therapeutic Medicine, 17(6), 4561. https://doi.org/10.3892/ETM.2019.7467
Schimberg, A. S., Wellenstein, D. J., Schutte, H. W., Honings, J., van den Hoogen, F. J. A., Marres, H. A. M., Takes, R. P., & van den Broek, G. B. (2022). Flexible Endoscopic Biopsy: Identifying Factors to Increase Accuracy in Diagnosing Benign and Malignant Laryngopharyngeal Pathology. Journal of Voice, 36(1), 128–133. https://doi.org/10.1016/j.jvoice.2020.04.015
Wellenstein, D. J., de Witt, J. K., Schutte, H. W., Honings, J., van den Hoogen, F. J. A., Marres, H. A. M., Takes, R. P., & van den Broek, G. B. (2017). Safety of flexible endoscopic biopsy of the pharynx and larynx under topical anesthesia. European Archives of Oto-Rhino-Laryngology, 274(9), 3471. https://doi.org/10.1007/S00405-017-4647-Z
Sulica, L., & Blitzer, A. (2000). Anesthesia for Laryngeal Surgery in the Office. The Laryngoscope, 110(10), 1777–1779. https://doi.org/10.1097/00005537-200010000-00040
Bredenkamp, J. K., Abemayor, E., Wackym, P. A., & Ward, P. H. (1990). Tonsillectomy under local anesthesia: a safe and effective alternative. American Journal of Otolaryngology, 11(1), 18–22. https://doi.org/10.1016/0196-0709(90)90165-R
White, J. (2020). PubMed 2.0. Medical Reference Services Quarterly, 39(4), 382–387. https://doi.org/10.1080/02763869.2020.1826228
Fiorini, N., Lipman, D. J., & Lu, Z. (2017). Towards PubMed 2.0. ELife, 6. https://doi.org/10.7554/ELIFE.28801
Luo, R., Kong, W., Wei, X., Lamb, J., & Jiang, J. J. (2020a). Development of Excised Larynx. Journal of Voice, 34(1), 38–43. https://doi.org/10.1016/j.jvoice.2018.07.023
Levitan, R., & Ochroch, E. A. (2000a). AIRWAY MANAGEMENT AND DIRECT LARYNGOSCOPY. Critical Care Clinics, 16(3), 373–388. https://doi.org/10.1016/S0749-0704(05)70118-4
Ruth, A. A. (2024). Striking a (vocal) chord: musical instruments as mnemonic devices when teaching the functional anatomy of the larynx. Advances in Physiology Education, 48(2), 284–287. https://doi.org/10.1152/advan.00070.2023
Coulter, J., Hohman, M. H., & Kwon, E. (2024). Otalgia.
Prescott, S. L., Umans, B. D., Williams, E. K., Brust, R. D., & Liberles, S. D. (2020). An Airway Protection Program Revealed by Sweeping Genetic Control of Vagal Afferents. Cell, 181(3), 574-589.e14. https://doi.org/10.1016/j.cell.2020.03.004
Bradley, S. M. (2018). Ultrasound, endoscopy, and the recurrent nerve. The Journal of Thoracic and Cardiovascular Surgery, 155(6), 2588–2590. https://doi.org/10.1016/j.jtcvs.2018.01.043
Brodsky, M. B., Akst, L. M., Jedlanek, E., Pandian, V., Blackford, B., Price, C., Cole, G., Mendez-Tellez, P. A., Hillel, A. T., Best, S. R., & Levy, M. J. (2021). Laryngeal Injury and Upper Airway Symptoms After Endotracheal Intubation During Surgery: A Systematic Review and Meta-analysis. Anesthesia & Analgesia, 132(4), 1023–1032. https://doi.org/10.1213/ANE.0000000000005276
Gray, S. D. (2000). CELLULAR PHYSIOLOGY OF THE VOCAL FOLDS. Otolaryngologic Clinics of North America, 33(4), 679–697. https://doi.org/10.1016/S0030-6665(05)70237-1
Aziz, T., Ansari, K., Lagravere, M. O., Major, M. P., & Flores-Mir, C. (2015). Effect of non-surgical maxillary expansion on the nasal septum deviation: a systematic review. Progress in Orthodontics, 16(1), 15. https://doi.org/10.1186/s40510-015-0084-y
Carrasco, A., Sjölander, I., Van Acker, A., Dernstedt, A., Fehrm, J., Forsell, M., Friberg, D., Mjösberg, J., & Rao, A. (2021). The Tonsil Lymphocyte Landscape in Pediatric Tonsil Hyperplasia and Obstructive Sleep Apnea. Frontiers in Immunology, 12. https://doi.org/10.3389/fimmu.2021.674080thr
Arambula, A., Brown, J. R., & Neff, L. (2021a). Anatomy and physiology of the palatine tonsils, adenoids, and lingual tonsils. World Journal of Otorhinolaryngology - Head and Neck Surgery, 7(3), 155–160. https://doi.org/10.1016/j.wjorl.2021.04.003
Šklebar, D., Vučemilo, L., & Šklebar, T. (2022). GLOSSOPHARYNGEAL NERVE AS A SOURCE OF OROFACIAL PAIN - DIAGNOSTIC AND THERAPEUTIC CHALLENGES. Acta Clinica Croatica, 61(Suppl 2), 90. https://doi.org/10.20471/ACC.2022.61.S2.11
Thomas, K., Minutello, K., & Das, J. M. (2024). Neuroanatomy, Cranial Nerve 9 (Glossopharyngeal).
Durbin, C. G., Bell, C. T., & Shilling, A. M. (2014). Elective IntubationDiscussion. Respiratory Care, 59(6), 825–849. https://doi.org/10.4187/respcare.02802
Langeron, O., Masso, E., Huraux, C., Guggiari, M., Bianchi, A., Coriat, P., & Riou, B. (2000a). Prediction of Difficult Mask Ventilation. Anesthesiology, 92(5), 1229–1236. https://doi.org/10.1097/00000542-200005000-00009
Vidhya, S., Sharma, B., Swain, B. P., & Singh, U. K. (2020a). Comparison of sensitivity, specificity, and accuracy of Wilson’s score and intubation prediction score for prediction of difficult airway in an eastern Indian population—A prospective single-blind study. Journal of Family Medicine and Primary Care, 9(3), 1436. https://doi.org/10.4103/JFMPC.JFMPC_1068_19
Hansel, J., Rogers, A. M., Lewis, S. R., Cook, T. M., & Smith, A. F. (2022). Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation. The Cochrane Database of Systematic Reviews, 2022(4). https://doi.org/10.1002/14651858.CD011136.PUB3
Siddiqui, K. M., Hameed, F., & Ali, M. A. (2021a). Diagnostic Accuracy of Combined Mallampati and Wilson Score to Predict Difficult Intubation in Obese Patients: A Descriptive Cross-sectional Study. Anesthesiology and Pain Medicine, 11(6). https://doi.org/10.5812/AAPM.118626
Kim, W. H., Ahn, H. J., Lee, C. J., Shin, B. S., Ko, J. S., Choi, S. J., & Ryu, S. A. (2011). Neck circumference to thyromental distance ratio: A new predictor of difficult intubation in obese patients. British Journal of Anaesthesia, 106(5), 743–748. https://doi.org/10.1093/bja/aer024
Markos, Z., Melesse, E., Getachew, L., & Haddis, L. (2022). Comparison of Mallampati test in sitting position and in supine position for prediction of difficult tracheal intubation among adult patients who underwent surgery under general anesthesia at Addis Ababa governmental hospitals 2021, comparative cross-sectional study. Annals of Medicine and Surgery, 82, 104711. https://doi.org/10.1016/J.AMSU.2022.104711
Mitchell, R. B., Archer, S. M., Ishman, S. L., Rosenfeld, R. M., Coles, S., Finestone, S. A., Friedman, N. R., Giordano, T., Hildrew, D. M., Kim, T. W., Lloyd, R. M., Parikh, S. R., Shulman, S. T., Walner, D. L., Walsh, S. A., & Nnacheta, L. C. (2019). Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngology - Head and Neck Surgery (United States), 160(1_suppl), S1–S42. https://doi.org/10.1177/0194599818801757/ASSET/IMAGES/LARGE/10.1177_0194599818801757-FIG2.JPEG
Guntinas-Lichius, O., Geißler, K., Mäkitie, A. A., Ronen, O., Bradley, P. J., Rinaldo, A., Takes, R. P., & Ferlito, A. (2023). Treatment of recurrent acute tonsillitis—a systematic review and clinical practice recommendations. Frontiers in Surgery, 10. https://doi.org/10.3389/FSURG.2023.1221932/FULL
Suvarna, D., & Fernandes, S. (2015). Anesthesia Management of Adenotonsillectomy. An International Journal of Otorhinolaryngology Clinics, 7(1), 17–21. https://doi.org/10.5005/JP-JOURNALS-10003-1181
Bangera, A. (2017b). Anaesthesia for adenotonsillectomy: An update. Indian Journal of Anaesthesia, 61(2), 103. https://doi.org/10.4103/0019-5049.199855
Davidson, A. J., Shrivastava, P. P., Jamsen, K., Huang, G. H., Czarnecki, C., Gibson, M. A., Stewart, S. A., & Stargatt, R. (2006). Risk factors for anxiety at induction of anesthesia in children: a prospective cohort study. Paediatric Anaesthesia, 16(9), 919–927. https://doi.org/10.1111/J.1460-9592.2006.01904.X
Garcia, A., Clark, E. A., Rana, S., Preciado, D., Jeha, G. M., Viswanath, O., Urits, I., Kaye, A. D., & Abdallah, C. (2021). Effects of Premedication With Midazolam on Recovery and Discharge Times After Tonsillectomy and Adenoidectomy. Cureus, 13(2). https://doi.org/10.7759/CUREUS.13101
Webb, N., Kars, M. S., Butler, A. L., Malesinska, M., & Smith, L. P. (2021). The use of laryngeal mask airway for tonsillectomy and adenoidectomy. International Journal of Pediatric Otorhinolaryngology, 144. https://doi.org/10.1016/J.IJPORL.2021.110691
Matovinović, F., Bacan, F., Kereković, E., Pegan, A., Rašić, I., & Košec, A. (2018). Risks and benefits of local anesthesia versus general anesthesia in tonsillectomy. American Journal of Otolaryngology, 39(5), 515–517. https://doi.org/10.1016/J.AMJOTO.2018.05.015
Naik, S. M., Naik, S. S., Ravishankara, S., Appaji, M. K., Goutham, M. K., Devi, N. P., & Mushannavar, A. S. (2014). Advantages of Tonsillectomy done under Local Anesthesia compared to General Anesthesia in Adults. International Journal of Head and Neck Surgery, 4(1), 13–18. https://doi.org/10.5005/JP-JOURNALS-10001-1129
Rao, S., & Rao, S. (2018). Glossopharyngeal Nerve Block: The Premolar Approach. Craniomaxillofacial Trauma & Reconstruction, 11(4), 331. https://doi.org/10.1055/S-0037-1606249
Ahmed, S. A., & Omara, A. F. (2019). The Effect of Glossopharyngeal Nerve Block on Post-Tonsillectomy Pain of Children; Randomized Controlled Trial. Anesthesiology and Pain Medicine, 9(2), 90854. https://doi.org/10.5812/AAPM.90854
You, S., Qin, X., Tong, L., & Feng, Z. (2024). Long-Term Follow-Up of Ultrasound-Guided Glossopharyngeal Nerve Block Treatment for Glossopharyngeal Neuralgia: A Retrospective Clinical Study of 43 Cases. Journal of Pain Research, 17, 913. https://doi.org/10.2147/JPR.S437609
Atlas, G., Sifonios, A., & Otero, J. (2013). Use of a laryngoscope, held sideways, as an aid in perforsming an intraoral glossopharyngeal nerve block. Journal of Anaesthesiology, Clinical Pharmacology, 29(1), 129. https://doi.org/10.4103/0970-9185.105827
Nagar, R. R., & Deshmukh, P. T. (2022). An Overview of the Tympanostomy Tube. Cureus, 14(10). https://doi.org/10.7759/CUREUS.30166
Isaacson, G. (2020a). Tympanostomy Tubes—A Visual Guide for the Young Otolaryngologist. Ear, Nose and Throat Journal, 99(1_suppl), 8S-14S. https://doi.org/10.1177/0145561320929885/ASSET/IMAGES/LARGE/10.1177_0145561320929885-FIG11.JPEG
Kanotra, S., Purbi, S., Bashir, S., & Sharma, P. (2022). Endoscopic Treatment of Otitis Media with Effusion. Indian Journal of Otolaryngology and Head & Neck Surgery, 74(Suppl 3), 4356. https://doi.org/10.1007/S12070-021-03012-X
Kanotra, S., Purbi, S., Bashir, S., & Sharma, P. (2022). Endoscopic Treatment of Otitis Media with Effusion. Indian Journal of Otolaryngology and Head & Neck Surgery, 74(Suppl 3), 4356. https://doi.org/10.1007/S12070-021-03012-X
Spaw, M., Agarwal, N., & Camacho, M. (2024). Tympanostomy Tube Insertion. The Lancet, 319(8285), 1362. https://doi.org/10.1016/S0140-6736(82)92432-1
Kay, D. J., Nelson, M., & Rosenfeld, R. M. (2001). Meta-Analysis of Tympanostomy Tube Sequelae. Otolaryngology–Head and Neck Surgery, 124(4), 374–380. https://doi.org/10.1067/MHN.2001.113941
Cohen, L. L., Robbertz, A. S., & England, L. J. (2022a). Behavioral Strategies to Minimize Procedural Distress During In-Office Pediatric Tympanostomy Tube Placement Without Sedation or Restraint. Journal of Clinical Psychology in Medical Settings, 29(2), 285. https://doi.org/10.1007/S10880-021-09813-0
Truitt, T. O., Kosko, J. R., Nimmons, G. L., Raisen, J., Skovlund, S. M., Rimell, F., & Cofer, S. A. (2021a). In‐office insertion tympanostomy tubes in children using single‐pass device. Laryngoscope Investigative Otolaryngology, 6(2), 325. https://doi.org/10.1002/LIO2.533
Lee, D. H., Jung, K., & Kim, H. (2015a). Age as a Determinant to Select an Anesthesia Method for Tympanostomy Tube Insertion in a Pediatric Population. Journal of Audiology & Otology, 19(1), 45. https://doi.org/10.7874/JAO.2015.19.1.45
Lee, D. H. (2016a). How do You Select an Anesthesia Method Prior to Tympanostomy Tube Insertion for a Child? Journal of Audiology & Otology, 20(3), 127. https://doi.org/10.7874/JAO.2016.20.3.127
Zeiders, J. W., Syms, C. A., Mitskavich, M. T., Yen, D. M., Harfe, D. T., Shields, R. D., Lanier, B. J., Gould, A. R., Mouzakes, J., & Elliott, C. L. (2015a). Tympanostomy tube placement in awake, unrestrained pediatric patients: A prospective, multicenter study. International Journal of Pediatric Otorhinolaryngology, 79(12), 2416–2423. https://doi.org/10.1016/J.IJPORL.2015.11.003
Yeung, B. P. M., & Gourlay, T. (2012). A technical review of flexible endoscopic multitasking platforms. International Journal of Surgery, 10(7), 345–354. https://doi.org/10.1016/J.IJSU.2012.05.009
Al Ghamdi, S. S., Farha, J., Moran, R. A., Pioche, M., Moll, F., Yang, D. J., Hernández Mondragón, O. V., Ujiki, M., Wong, H., Tantau, A., Sedarat, A., Fejleh, M. P., Chang, K., Lee, D. P., Nieto, J. M., Andrawes, S., Ginsberg, G. G., Saumoy, M., Bapaye, A., … Khashab, M. A. (2022). Zenker’s peroral endoscopic myotomy, or flexible or rigid septotomy for Zenker’s diverticulum: a multicenter retrospective comparison. Endoscopy, 54(4), 345–351. https://doi.org/10.1055/A-1518-7223
Printza, A., Sdravou, K., & Triaridis, S. (2022). Dysphagia Management in Children: Implementation and Perspectives of Flexible Endoscopic Evaluation of Swallowing (FEES). Children, 9(12). https://doi.org/10.3390/CHILDREN9121857
Aviv, J. E. (2000). Clinical assessment of pharyngolaryngeal sensitivity. American Journal of Medicine, 108(4 SUPPL. 1), 68–72. https://doi.org/10.1016/S0002-9343(99)00338-1
Haller, L., Osterbauer, B., Maldonado, K., Bhardwaj, V., Bansal, M., Peck, K., & Hochstim, C. (2020). Factors Impacting Participation in Flexible Endoscopic Evaluation of Swallowing in Children. International Journal of Pediatric Otorhinolaryngology, 138, 110323. https://doi.org/10.1016/J.IJPORL.2020.110323
Cho, Y. J. (2021). Role of Anesthesia in Endoscopic Operations. Gastrointestinal Endoscopy Clinics of North America, 31(4), 759–772. https://doi.org/10.1016/j.giec.2021.05.011
Wellenstein, D. J., van der Wal, R. A. B., Schutte, H. W., Honings, J., van den Hoogen, F. J. A., Marres, H. A. M., Takes, R. P., & van den Broek, G. B. (2019). Topical Anesthesia for Endoscopic Office-based Procedures of the Upper Aerodigestive Tract. Journal of Voice : Official Journal of the Voice Foundation, 33(5), 732–746. https://doi.org/10.1016/J.JVOICE.2018.02.006
O’Dell, K. (2015). Predictors of Difficult Intubation and the Otolaryngology Perioperative Consult. Anesthesiology Clinics, 33(2), 279–290. https://doi.org/10.1016/j.anclin.2015.02.002
Joshi, K., Woodard, T., Borghei-Razavi, H., Recinos, P. F., & Kshettry, V. R. (2019). Endoscopic Endonasal Odontoidectomy. Journal of Neurological Surgery. Part B, Skull Base, 80(Suppl 4), S370–S370. https://doi.org/10.1055/S-0039-1700510
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Agnieszka Parfianowicz, Alicja Surma, Arkadiusz Jaworski, Filip Grajnert, Jakub Plizga, Agnieszka Głuszczyk, Jakub Cecot, Konrad Zarzecki, Miłosz Mandryk, Nazar Holdun
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 208
Number of citations: 0
