ABSTRACT
OBJECTIVE: Peritonsillar abscess (PTA) is a common pediatric infection requiring drainage. Conscious Sedation (CS) can facilitate drainage in uncooperative children. However, it carries risks, especially if the airway is compromised. Moreover, evidence on its safety and efficacy is limited. This study examined the safety, pain reduction, and anxiety management of hospitalized pediatric patients treated for PTA under CS. MATERIALS AND METHODS: We performed a prospective observational case series of 118 children aged 2-15 years with 155 PTA episodes, managed from 2016 to 2023. Conscious sedation was used in 42 episodes. Outcomes were compared among CS and non-CS (local anesthesia only). Complications assessed safety. Efficacy was evaluated by the amount of pus, hospitalization parameters, pain scores, and recurrence. RESULTS: No significant differences were found regarding the demographic and presentation parameters except for younger age among the CS group (9 vs 11 years p = 0.001). One minor oxygen desaturation (2 %) event occurred with CS. Abscess drainage amount was greater with CS than non-CS, 4.9±4 mL vs. 3.2±2 mL, respectively (p = 0.03). Hospitalization stays were similar among groups. Maximum pain scores were lower with CS than non-CS, 1.4 ± 2 vs 4.2 ± 3 (p < 0.001); similarly, IV pain medication was used less frequently, 0.9 ± 1 vs. 1.6 ± 3 (p = 0.045), and the need for re-aspiration was less common 14 % vs. 28 % (p = 0.04), with CS than non-CS, respectively. The three-month recurrence rate was numerically lower with CS (5 % vs. 14 % non-CS). CONCLUSIONS: Conscious sedation facilitates PTA drainage with excellent safety and improved efficacy compared to local anesthesia in children. Pain scores are reduced both during drainage and hospitalization. Our prospective data add to the limited evidence supporting CS as a viable option for abscess drainage in uncooperative pediatric patients. Further study is warranted to confirm potential long-term reductions in recurrence.
ABSTRACT
The association fibers of the superior longitudinal fasciculus (SLF) connect parietal and frontal cortical regions in the human brain. The SLF comprises of three distinct sub-bundles, each presenting a different anatomical trajectory, and specific functional roles. Nevertheless, in vivo studies of the SLF often consider the entire SLF complex as a single entity. In this work, we suggest a data-driven approach that relies on microstructure measurements for separating SLF-III from the rest of the SLF. We apply the SLF-III separation procedure in three independent datasets using parameters of diffusion MRI (fractional anisotropy), as well as relaxometry-based parameters (T1, T2, T2* and T2-weighted/T1-weighted). We show that the proposed procedure is reproducible across datasets and tractography algorithms. Finally, we suggest that differential crossing with different white-matter tracts is the source of the distinct MRI signatures of SLF-II and SLF-III.
