Probing for nasolacrimal duct obstruction using intranasal midazolam sedation as an alternative to general anesthesia.
OBJECTIVE
To investigate the effectiveness of topical anesthesia with sedation using intranasal midazolam in patients with symptomatic congenital nasolacrimal duct obstruction undergoing probing.


METHODS
In this prospective study, probing was performed with general anesthesia (30 cases) and with topical anesthesia using intranasal midazolam (0.3 mg/kg; 44 cases) in 74 patients who were divided into two groups, those 6 to 36 months old and those older than 36 months. The groups were compared after 12 to 48 months (mean, 18.2 months).


RESULTS
For the patients 6 to 36 months old, the success rate was 80% in the group who received general anesthesia and 88.9% in the group who received topical anesthesia with intranasal midazolam; the difference between the two groups was not statistically significant (P > .05). For the patients older than 36 months, the success rate was 20% in the group who received general anesthesia and 25% in the group who received topical anesthesia with intranasal midazolam; there was no statistically significant difference between the two groups (P > .05).


CONCLUSIONS
Probing with topical anesthesia in the office setting is usually recommended for patients younger than 8 months. Our results show that this is suitable for children until 4 years of age with the support of intranasal midazolam sedation. Probing under topical anesthesia with intranasal midazolam is cost-effective, safe, and comparable in efficacy to probing under general anesthesia but with less risk.
Karabas
Levent V
LV
Ophthalmology Department, Kocaeli University School of Medicine, Turkey.
Elibol
Orhan
O
Yüksel
Nursen
N
Gürkan
Yavuz
Y
Altintas
Ozgül
O
Caglar
Yusuf
Y
D000281:Administration, Intranasal; D000768:Anesthesia, General / Q000379:methods; D000772:Anesthesia, Local / Q000379:methods*; D002675:Child, Preschool; D003608:Dacryocystorhinostomy; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007223:Infant; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D009301:Nasolacrimal Duct; D013508:Ophthalmologic Surgical Procedures; D011446:Prospective Studies; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D008874:Midazolam