MRI Induction Room as Safe as OR for Pediatric Patients Undergoing DISE

How do drug-induced sleep endoscopies (DISE) performed on children in the operating room (OR) compare to those performed in the MRI induction room?

Bottom Line: There were no significant complications for DISE performed on child patients in the OR or in the MRI induction room.

Background: Children with persistent obstructive sleep apnea (OSA) typically receive DISE, during which a flexible laryngoscope is used to evaluate inner structures. Requiring anesthesia, DISE is generally performed in the OR; however, it can also be done in an MRI induction room to enable imaging procedures while the patient is in a sleep-like state.

Study Design: Prospective study versus control group case-series in a single institution.

Setting: Division of Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati.

Synopsis: Researchers prospectively assessed 118 patients (mean age = 10.6 years) who had been referred for DISE with persistent OSA following adenotonsillectomy. Eighty patients underwent DISE in the OR (OR group) and 38 underwent the procedure in the MRI induction room (radiology group). Costs were estimated based on patient charges in both settings. Major complications were defined as death, cardiac arrest, or the need for overnight hospitalization due to persistent severe obstruction. Researchers found that DISE performed in radiology was safe when compared to the OR procedures. Performance times were similar; the “induction to exit room time” was shorter for the radiology group. A benefit of the MRI induction room is the ability to couple DISE with a cine MRI, which allows for complementary information in evaluating patients and limits anesthesia to a single exposure. Performing DISE outside the OR resulted in significant cost savings for patients, but this is partly due to the greater complexity of cases for which an OR is a safer option. Limitations include the absence of randomization, resulting in selection bias, and conditions that limited result generalizability.

Citation: Bergeron M, Lee DR, DeMarcantonio MA, et al. Safety and cost of drug-induced sleep endoscopy outside the operating room. Laryngoscope. 130;8:2076-2080.