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Pediatrik Gastrointestinal Endoskopi Uygulamasında Anestezi Deneyimlerimiz: Retrospektif Çalışma

Year 2021, Volume: 18 Issue: 3, 390 - 394, 29.12.2021
https://doi.org/10.35440/hutfd.998930

Abstract

Amaç: Son yıllarda artan pediatrik gastrointestinal endoskopi uygulamasında hasta konforu ve işlemin daha kolay uygulanabilmesi açısından derin sedasyona ihtiyaç duyulmaktadır. Bu çalışmadaki amacımız ketamin ve propofol kombinasyonun pediatrik gastrointestinal endoskopide etkinliğini araştırmaktır.
Materyal ve metod: Aralık 2017 ve Mart 2019 tarihleri arasında ketamin ve propofol kombinasyonu ile sedoanaljezi yapılan pediatrik gastrointestinal endoskopi yapılan hastalar tarandı. Hastaların yaşı, cinsiyeti, ek ilaç ihtiyacı, komorbit durumlar, işlemin endikasyonları, meydana gelen komplikasyonlar, işlem süresi, derlenme süresi ve işlem sonrası bekleme süresi kaydedildi.
Bulgular: Çalışmaya 202 erkek, 195 kadın toplam 397 hasta dahil edildi. Ortalama yaşları 9.22±4.72 idi. Vakaların endoskopik ön tanıları incelendiğinde, en yüksek oranda (%53.4) karın ağrısı, ikinci olarak çölyak hastalığı ön tanısı (%15,3) ile alındığı dosya taramasından anlaşıldı. Vakaların işlem süresi 19.77±8.48, derlenme süresi 10.3±3.83 ve işlem sonrası bekleme süresi 17.41±4.19 olarak tespit edildi. Hastaların %20.7’sinda ek propofol ihtiyacı olmuştur. Vakaların,%3.3’nde (13 vaka) komplikasyon görülmüştür
Sonuç: Yaptığımız retrospektif incelemede, 397 hastada propofol ve ketamin kombinasyonu ile başarılı bir şekilde sedasyon sağlanmış olup düşük komplikasyon oranları tespit edilmiştir. Bu nedenle pediatrik gastrointestinal endoskopi uygulamalarında propofol ve ketamin kombinasyonun güvenle uygulanabileceğini düşünmekteyiz

Supporting Institution

yok

Project Number

yok

References

  • Friedt M, Welsch S. An update on pediatric endoscopy. Eur J Med Res. 2013 Jul 25;18(1):24. doi: 10.1186/2047-783X-18-24. PMID: 23885793; PMCID: PMC3751043.
  • Franciosi JP, Fiorino K, Ruchelli E, Shults J, Spergel J, et al. Changing indications for upper endoscopy in children during a 20-year period. J Pediatr Gastroenterol Nutr. 2010 Oct;51(4):443-7. doi: 10.1097/MPG.0b013e3181d67bee. PMID: 20562722; PMCID: PMC2946469.
  • Isik IA, Iyilikçi L, Ozturk Y, Adiyaman E. Sedation Practice Outside the Operating Room for Pediatric Gastrointestinal Endoscopy. Indian Pediatr. 2015 Nov;52(11):989-90. doi: 10.1007/s13312-015-0761-4. PMID: 26615354.
  • American Academy of Pediatrics; American Academy of Pediatric Dentistry, Coté CJ, Wilson S; Work Group on Sedation. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006 Dec;118(6):2587-602. doi: 10.1542/peds.2006-2780. PMID: 17142550.
  • Lightdale JR, Liu QY, Sahn B, Troendle DM, Thomson M, Fishman DS; NASPGHAN Endoscopy and Procedures Committee. Pediatric Endoscopy and High-risk Patients: A Clinical Report From the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr. 2019 Apr;68(4):595-606. doi: 10.1097/MPG.0000000000002277. PMID: 30664560.
  • Tringali A, Thomson M, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, et al. Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary. Endoscopy. 2017 Jan;49(1):83-91. doi: 10.1055/s-0042-111002. Epub 2016 Sep 12. PMID: 27617420.
  • Krauss B, Green SM. Procedural sedation and analgesia in children. Lancet. 2006 Mar 4;367(9512):766-80. doi: 10.1016/S0140-6736(06)68230-5. PMID: 16517277.
  • Scottish Intercollegiate Guidelines Network. SIGN Guideline 58: safe sedation of children undergoing diagnostic and therapeutic procedures. Paediatr Anaesth. 2008 Jan;18(1):11-2. doi: 10.1111/j.1460-9592.2007.02405.x. PMID: 18095959.
  • Apfelbaum JL, Grasela TH, Hug CC Jr, McLeskey CH, Nahrwold ML, Roizen MF, et al. The initial clinical experience of 1819 physicians in maintaining anesthesia with propofol: characteristics associated with prolonged time to awakening. Anesth Analg. 1993 Oct;77(4 Suppl):S10-4. PMID: 8214691.
  • Nguyen VX, Le Nguyen VT, Nguyen CC. Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: up-to-date indications for primary care providers. Int J Gen Med. 2010 Nov 1;3:345-57. doi: 10.2147/IJGM.S14555. PMID: 21116340; PMCID: PMC2990396.
  • Lightdale JR, Mahoney LB, Schwarz SM, Liacouras CA. Methods of sedation in pediatric endoscopy: a survey of NASPGHAN members. J Pediatr Gastroenterol Nutr. 2007 Oct;45(4):500-2. doi: 10.1097/MPG.0b013e3180691168. PMID: 18030225.
  • Fredette ME, Lightdale JR. Endoscopic sedation in pediatric practice. Gastrointest Endosc Clin N Am. 2008 Oct;18(4):739-51, ix. doi: 10.1016/j.giec.2008.06.006. PMID: 18922412.
  • Khalila A, Shavit I, Shaoul R. Propofol Sedation by Pediatric Gastroenterologists for Endoscopic Procedures: A Retrospective Analysis. Front Pediatr. 2019 Mar 26;7:98. doi: 10.3389/fped.2019.00098. PMID: 30972312; PMCID: PMC6445344.
  • Amornyotin S, Aanpreung P, Prakarnrattana U, Chalayonnavin W, Chatchawankitkul S, Srikureja W. Experience of intravenous sedation for pediatric gastrointestinal endoscopy in a large tertiary referral center in a developing country. Paediatr Anaesth. 2009 Aug;19(8):784-91. doi: 10.1111/j.1460-9592.2009.03063.x. PMID: 19624366.
  • Martinez JL, Sutters KA, Waite S, Davis J, Medina E, Montano N, et al. A comparison of oral diazepam versus midazolam, administered with intravenous meperidine, as premedication to sedation for pediatric endoscopy. J Pediatr Gastroenterol Nutr. 2002 Jul;35(1):51-8. doi: 10.1097/00005176-200207000-00012. PMID: 12142810.
  • Cohen LB, Wecsler JS, Gaetano JN, Benson AA, Miller KM, Durkalski V, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol. 2006 May;101(5):967-74. doi: 10.1111/j.1572-0241.2006.00500.x. PMID: 16573781.
  • Kaddu R, Bhattacharya D, Metriyakool K, Thomas R, Tolia V. Propofol compared with general anesthesia for pediatric GI endoscopy: is propofol better? Gastrointest Endosc. 2002 Jan;55(1):27-32. doi: 10.1067/mge.2002.120386. PMID: 11756910.
  • Green SM, Klooster M, Harris T, Lynch EL, Rothrock SG. Ketamine sedation for pediatric gastroenterology procedures. J Pediatr Gastroenterol Nutr. 2001 Jan;32(1):26-33. doi: 10.1097/00005176-200101000-00010. Erratum in: J Pediatr Gastroenterol Nutr 2001 Feb;32(2):234. PMID: 11176320.
  • Tosun Z, Aksu R, Guler G, Esmaoglu A, Akin A, Aslan D, et al. Propofol-ketamine vs propofol-fentanyl for sedation during pediatric upper gastrointestinal endoscopy. Paediatr Anaesth. 2007 Oct;17(10):983-8. doi: 10.1111/j.1460-9592.2007.02206.x. PMID: 17767636.
  • Ament ME. Prospectivestudy of risks of complication in 6,424 procedures in pediatricgastroenterology. Pediatr Res1981;15:524.
  • Gilger MA, Spearman RS, Dietrich CL, Spearman G, Wilsey MJ Jr, Zayat MN. Safety and effectiveness of ketamine as a sedative agent for pediatric GI endoscopy. Gastrointest Endosc. 2004 May;59(6):659-63. doi: 10.1016/s0016-5107(04)00180-4. PMID: 15114309.
  • Soyalp C, Yüzkat N. "Pediatrik hastalarda ameliyathane dışı anestezi uygulamalarımız: Retrospektif çalışma." Van Tıp Dergisi 26.2 (2019): 248-253
  • Koh JL, Black DD, Leatherman IK, Harrison RD, Schmitz ML. Experience with an anesthesiologist interventional model for endoscopy in a pediatric hospital. J Pediatr Gastroenterol Nutr. 2001 Sep;33(3):314-8. doi: 10.1097/00005176-200109000-00016. PMID: 11593128.
  • Yang SM, Yi DY, Choi GJ, Lim IS, Chae SA, Yun SW, et al. Effects of Sedation Performed by an Anesthesiologist on Pediatric Endoscopy: a Single-Center Retrospective Study in Korea. J Korean Med Sci. 2020 Jun 1;35(21):e183. doi: 10.3346/jkms.2020.35.e183. PMID: 32476304; PMCID: PMC7261697.
  • Schmitz A, Weiss M, Kellenberger C, O'Gorman Tuura R, Klaghofer R, Scheer I, et al. Sedation for magnetic resonance imaging using propofol with or without ketamine at induction in pediatrics-A prospective randomized double-blinded study. Paediatr Anaesth. 2018 Mar;28(3):264-274. doi: 10.1111/pan.13315. Epub 2018 Jan 27. PMID: 29377404.
  • Motamed F, Aminpour Y, Hashemian H, Soltani AE, Najafi M, Farahmand F. Midazolam-ketamine combination for moderate sedation in upper GI endoscopy. J Pediatr Gastroenterol Nutr. 2012 Mar;54(3):422-6. doi: 10.1097/MPG.0b013e3182323c75. PMID: 21857244.

Our Anesthesia Experience in Pediatric Gastrointestinal Endoscopy Application: Retrosepective Study

Year 2021, Volume: 18 Issue: 3, 390 - 394, 29.12.2021
https://doi.org/10.35440/hutfd.998930

Abstract

Background: In the practice of pediatric gastrointestinal endoscopy, which has increased in recent years, deep sedation is needed for patient comfort and easier application of the procedure. Our aim in this study is to investigate the efficacy of ketamine and propofol combination in pediatric gastrointestinal endoscopy.
Materials and Methods: Patients who was applied sedoanalgesia with a combination of ketamine and propofol for pediatric gastrointestinal endoscopy between December 2017 and March 2019, were screened. The patients' age, gender, need for additional medication, comorbid conditions, indications of the procedure, complications, duration of the procedure, recovery time and waiting period after the procedure were recorded.
Results: A total of 397 patients, 202 male and 195 female, were included in the study. Their mean age was 9.22±4.72 years. When the endoscopic prediagnoses of the cases were examined, the highest rate (53.4%) was abdominal pain and the second prediagnosis of celiac disease (15.3%) was found. The duration of the procedure was 19.77±8.48, the recovery period was 10.3±3.83 and the waiting time after the procedure was 17.41±4.19. Additional propofol was needed in 20.7% of the patients. Complications were seen in 3.3% (13 cases) of cases.
Conclusion: In our retrospective review, sedation was successfully achieved with the combination of propofol and ketamine in 397 patients, and low complication rates were detected. Therefore, we think that the combination of propofol and ketamine can be safely applied in pediatric gastrointestinal endoscopy applications.

Project Number

yok

References

  • Friedt M, Welsch S. An update on pediatric endoscopy. Eur J Med Res. 2013 Jul 25;18(1):24. doi: 10.1186/2047-783X-18-24. PMID: 23885793; PMCID: PMC3751043.
  • Franciosi JP, Fiorino K, Ruchelli E, Shults J, Spergel J, et al. Changing indications for upper endoscopy in children during a 20-year period. J Pediatr Gastroenterol Nutr. 2010 Oct;51(4):443-7. doi: 10.1097/MPG.0b013e3181d67bee. PMID: 20562722; PMCID: PMC2946469.
  • Isik IA, Iyilikçi L, Ozturk Y, Adiyaman E. Sedation Practice Outside the Operating Room for Pediatric Gastrointestinal Endoscopy. Indian Pediatr. 2015 Nov;52(11):989-90. doi: 10.1007/s13312-015-0761-4. PMID: 26615354.
  • American Academy of Pediatrics; American Academy of Pediatric Dentistry, Coté CJ, Wilson S; Work Group on Sedation. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006 Dec;118(6):2587-602. doi: 10.1542/peds.2006-2780. PMID: 17142550.
  • Lightdale JR, Liu QY, Sahn B, Troendle DM, Thomson M, Fishman DS; NASPGHAN Endoscopy and Procedures Committee. Pediatric Endoscopy and High-risk Patients: A Clinical Report From the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr. 2019 Apr;68(4):595-606. doi: 10.1097/MPG.0000000000002277. PMID: 30664560.
  • Tringali A, Thomson M, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, et al. Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary. Endoscopy. 2017 Jan;49(1):83-91. doi: 10.1055/s-0042-111002. Epub 2016 Sep 12. PMID: 27617420.
  • Krauss B, Green SM. Procedural sedation and analgesia in children. Lancet. 2006 Mar 4;367(9512):766-80. doi: 10.1016/S0140-6736(06)68230-5. PMID: 16517277.
  • Scottish Intercollegiate Guidelines Network. SIGN Guideline 58: safe sedation of children undergoing diagnostic and therapeutic procedures. Paediatr Anaesth. 2008 Jan;18(1):11-2. doi: 10.1111/j.1460-9592.2007.02405.x. PMID: 18095959.
  • Apfelbaum JL, Grasela TH, Hug CC Jr, McLeskey CH, Nahrwold ML, Roizen MF, et al. The initial clinical experience of 1819 physicians in maintaining anesthesia with propofol: characteristics associated with prolonged time to awakening. Anesth Analg. 1993 Oct;77(4 Suppl):S10-4. PMID: 8214691.
  • Nguyen VX, Le Nguyen VT, Nguyen CC. Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: up-to-date indications for primary care providers. Int J Gen Med. 2010 Nov 1;3:345-57. doi: 10.2147/IJGM.S14555. PMID: 21116340; PMCID: PMC2990396.
  • Lightdale JR, Mahoney LB, Schwarz SM, Liacouras CA. Methods of sedation in pediatric endoscopy: a survey of NASPGHAN members. J Pediatr Gastroenterol Nutr. 2007 Oct;45(4):500-2. doi: 10.1097/MPG.0b013e3180691168. PMID: 18030225.
  • Fredette ME, Lightdale JR. Endoscopic sedation in pediatric practice. Gastrointest Endosc Clin N Am. 2008 Oct;18(4):739-51, ix. doi: 10.1016/j.giec.2008.06.006. PMID: 18922412.
  • Khalila A, Shavit I, Shaoul R. Propofol Sedation by Pediatric Gastroenterologists for Endoscopic Procedures: A Retrospective Analysis. Front Pediatr. 2019 Mar 26;7:98. doi: 10.3389/fped.2019.00098. PMID: 30972312; PMCID: PMC6445344.
  • Amornyotin S, Aanpreung P, Prakarnrattana U, Chalayonnavin W, Chatchawankitkul S, Srikureja W. Experience of intravenous sedation for pediatric gastrointestinal endoscopy in a large tertiary referral center in a developing country. Paediatr Anaesth. 2009 Aug;19(8):784-91. doi: 10.1111/j.1460-9592.2009.03063.x. PMID: 19624366.
  • Martinez JL, Sutters KA, Waite S, Davis J, Medina E, Montano N, et al. A comparison of oral diazepam versus midazolam, administered with intravenous meperidine, as premedication to sedation for pediatric endoscopy. J Pediatr Gastroenterol Nutr. 2002 Jul;35(1):51-8. doi: 10.1097/00005176-200207000-00012. PMID: 12142810.
  • Cohen LB, Wecsler JS, Gaetano JN, Benson AA, Miller KM, Durkalski V, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol. 2006 May;101(5):967-74. doi: 10.1111/j.1572-0241.2006.00500.x. PMID: 16573781.
  • Kaddu R, Bhattacharya D, Metriyakool K, Thomas R, Tolia V. Propofol compared with general anesthesia for pediatric GI endoscopy: is propofol better? Gastrointest Endosc. 2002 Jan;55(1):27-32. doi: 10.1067/mge.2002.120386. PMID: 11756910.
  • Green SM, Klooster M, Harris T, Lynch EL, Rothrock SG. Ketamine sedation for pediatric gastroenterology procedures. J Pediatr Gastroenterol Nutr. 2001 Jan;32(1):26-33. doi: 10.1097/00005176-200101000-00010. Erratum in: J Pediatr Gastroenterol Nutr 2001 Feb;32(2):234. PMID: 11176320.
  • Tosun Z, Aksu R, Guler G, Esmaoglu A, Akin A, Aslan D, et al. Propofol-ketamine vs propofol-fentanyl for sedation during pediatric upper gastrointestinal endoscopy. Paediatr Anaesth. 2007 Oct;17(10):983-8. doi: 10.1111/j.1460-9592.2007.02206.x. PMID: 17767636.
  • Ament ME. Prospectivestudy of risks of complication in 6,424 procedures in pediatricgastroenterology. Pediatr Res1981;15:524.
  • Gilger MA, Spearman RS, Dietrich CL, Spearman G, Wilsey MJ Jr, Zayat MN. Safety and effectiveness of ketamine as a sedative agent for pediatric GI endoscopy. Gastrointest Endosc. 2004 May;59(6):659-63. doi: 10.1016/s0016-5107(04)00180-4. PMID: 15114309.
  • Soyalp C, Yüzkat N. "Pediatrik hastalarda ameliyathane dışı anestezi uygulamalarımız: Retrospektif çalışma." Van Tıp Dergisi 26.2 (2019): 248-253
  • Koh JL, Black DD, Leatherman IK, Harrison RD, Schmitz ML. Experience with an anesthesiologist interventional model for endoscopy in a pediatric hospital. J Pediatr Gastroenterol Nutr. 2001 Sep;33(3):314-8. doi: 10.1097/00005176-200109000-00016. PMID: 11593128.
  • Yang SM, Yi DY, Choi GJ, Lim IS, Chae SA, Yun SW, et al. Effects of Sedation Performed by an Anesthesiologist on Pediatric Endoscopy: a Single-Center Retrospective Study in Korea. J Korean Med Sci. 2020 Jun 1;35(21):e183. doi: 10.3346/jkms.2020.35.e183. PMID: 32476304; PMCID: PMC7261697.
  • Schmitz A, Weiss M, Kellenberger C, O'Gorman Tuura R, Klaghofer R, Scheer I, et al. Sedation for magnetic resonance imaging using propofol with or without ketamine at induction in pediatrics-A prospective randomized double-blinded study. Paediatr Anaesth. 2018 Mar;28(3):264-274. doi: 10.1111/pan.13315. Epub 2018 Jan 27. PMID: 29377404.
  • Motamed F, Aminpour Y, Hashemian H, Soltani AE, Najafi M, Farahmand F. Midazolam-ketamine combination for moderate sedation in upper GI endoscopy. J Pediatr Gastroenterol Nutr. 2012 Mar;54(3):422-6. doi: 10.1097/MPG.0b013e3182323c75. PMID: 21857244.
There are 26 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Mehmet Duran 0000-0001-7568-3537

Mehmet Tepe 0000-0002-2596-1284

Mevlüt Doğukan 0000-0002-4890-758X

Fadime Tosun 0000-0003-4660-5497

Aykut Direkci 0000-0001-7784-7267

Project Number yok
Publication Date December 29, 2021
Submission Date September 22, 2021
Acceptance Date November 10, 2021
Published in Issue Year 2021 Volume: 18 Issue: 3

Cite

Vancouver Duran M, Tepe M, Doğukan M, Tosun F, Direkci A. Pediatrik Gastrointestinal Endoskopi Uygulamasında Anestezi Deneyimlerimiz: Retrospektif Çalışma. Harran Üniversitesi Tıp Fakültesi Dergisi. 2021;18(3):390-4.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty