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• W1970865982 abstract "<h3>Background</h3> Early, accurate diagnosis of PID is essential to institute effective therapy and prevent sequelae, but the clinical diagnosis of PID is accurate in only 60 to 70% of patients. We aim to describe the use of high-resolution fiberoptic micro-laparoscopy with local anesthesia in adolescents who present with suspected PID, to evaluate tolerability and feasibility of the procedure, and to detennine if micro-laparoscopy improves diagnostic accuracy. <h3>Methods</h3> Patients presenting to Children's Hospital in Boston with uncomplicated PID were eligible. Exclusion criteria were pregnancy, prior mid-abdominal surgery, obesity, enlarged uterus, bleeding disorder, or high risk for anesthesia. Controls were patients who refused or presented when the surgeon was unavailable. The conscious sedation protocol included application of EMLA cream and lidocaine, intravenous midazolam and fentanyl, and continuous monitoring. Laparoscopy was perfonned using 2mm instrumentation, and cultures were obtained. Patients were observed for at least 30 minutes post-procedure. Pain was assessed at 4 times before and after the procedure with a visual analog scale, and patients completed an assessment 30 minutes and 24 hours after laparoscopy <h3>Results</h3> There were 4 patients in the laparoscopy group and 7 controls (1 refused. 6 surgeon was unavailable). Mean age of laparoscopy patients was 19.2 years and of controls 17.3 years. Mean induction time was 15.0 minutes and mean operative time 15.5 minutes. Mean dose of fentanyl was 237meg (range 125–350meg) and of midazolarn 3mg (range 2–5mg). There was one complication. a brief episode of desaturation that resolved with Narcan. Mean pain (scale 0 to 10) was 4.6±2.6 pre-procedure. 5.1±3.1 30 minutes post-procedure. 4.0±3.3 at 24 hours, and 1.5±1.1 at 48 hours. At 24 hours, 1/4 reported concern that laparoscopy would cause bleeding, 2/4 that it would be painful, and 1/4 that a serious problem might be identified. None reported concern that the medications would have side effects. When asked if there was anything that could have been done to make the process easier or more comfortable, 1/4 desired a better explanation of the medication side effects and 1/4 a better explanation of the duration of the procedure. None desired a better explanation of how much pain they would feel or what the providers might find. or would have preferred more medication for pain or anxiety. All laparoscopy patients (4/4) had a discharge diagnosis of PID. Of controls, 43% (3/7) had a discharge diagnosis of non-PID abdominal pain, 14% (1/7) dysfunctional uterine bleeding, 57% (4/7) ovarian cyst, and 29% (2/7) PID. <h3>Conclusions</h3> Micro-laparoscopy with conscious sedation in an emergency department is a feasible and well-tolerated procedure in adolescents with suspected PID." @default.
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• W1970865982 date "1997-08-01" @default.
• W1970865982 modified "2023-09-25" @default.
• W1970865982 title "Micro-laparoscopy with Conscious Sedation for the Evaluation of Suspected Pid in Adolescents: A Preliminary Report" @default.
• W1970865982 doi "https://doi.org/10.1016/s1083-3188(97)70219-5" @default.
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