Surgical and anesthetic considerations in histrelin capsule implantation for the treatment of precocious puberty.
BACKGROUND
Precocious puberty treatment traditionally meant anxiety-provoking monthly depot injections until the advent of the annually implanted histrelin capsule. This study is the first to evaluate the surgical and anesthetic aspects of histrelin implantation for precocious puberty.


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).


CONCLUSIONS
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.
Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
James S
JS
Davis
Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL.
Fuad
F
Alkhoury
Department of Pediatric Surgery, Miami Children's Hospital, Miami, FL; Department of Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, FL. Electronic address: cburnweit@aol.com.
Cathy
C
Burnweit
D000768:Anesthesia, General; D000772:Anesthesia, Local; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D002214:Capsules; D002648:Child; D016292:Procedural Sedation / Q000379:methods; D017046:Cost Savings; D020878:Device Removal; D004343:Drug Implants / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D004868:Equipment Failure; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology; D007239:Infections / Q000209:etiology; D008297:Male; D009609:Nitrous Oxide / Q000008:administration & dosage; D011629:Puberty, Precocious / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors
D018685:Anesthetics, Inhalation; D002214:Capsules; D004343:Drug Implants; D007987:Gonadotropin-Releasing Hormone; C029256:histrelin; D009609:Nitrous Oxide
Conscious sedation; Histrelin; Implant; Precocious puberty; Subcutaneous