Retrospective analysis of deep sedation in pediatric population for endoscopic procedures: adverse events and outcomes

Yıl 2015, Cilt: 2 Sayı: 4, 260 - 66, 08.04.2015

Berrin Isik Volkan Sivgin Mustafa Arslan , Seyfi Kartal Yusuf Unal Mehmet Akcabay

Öz

Background: Upper gastrointestinal endoscopy (E) and colonoscopy (C) procedures are not well tolerated in pediatric population. General anesthesia or sedation applied during gastroendoscopic procedures. This study is done to review our sedation practice and to evaluate the clinical effectiveness and side effects of an anaesthesiologist administered deep sedation for gastroendoscopic procedures outside the operating room.

Methods: After Institutional Review Board Approval, the charts of all children who underwent endoscopic procedure at the outpatient endoscopy suite under sedation, (Jan 2011- December 2011) were reviewed retrospectively. 

Results: Deep sedation was used in 301 procedures, which 255 were endoscopic and 23 were colonoscopic procedures. Twenty-three children had both procedures performed in one session. Demographic details:  Age [year, mean]: 10,1±5,1, Gender (M/F): 152/149, Body weight [kg, (mean±SD )]: 35.7±18.7. Severe bradycardia with oxygen desaturation was recorded in two patients. All procedures were carried out successfully. Emergence delirium was seen in only one patient who was the substance user. No significant side effect derived from intervention was observed during the procedures, except one case (perforation of the colon).

Conclusion: Deep sedation applied by anesthesiologist found to be adequately safe and appropriate for children during gastroendoscopic procedures.

Anahtar Kelimeler

Child; Complication; Sedation; Ambulatory anesthesia

Retrospective analysis of deep sedation in pediatric population for endoscopic procedures: adverse events and outcomes

Öz

Kaynakça

• Lighdale J. Methods of Sedation in Pediatric Endoscopy: A Survey of NASPGHAN Members. J Pediatr Gastroenterol Nutr 2007;45:500-502.
• ASGE STANDARDS OF PRACTICE COMMITTEE. Modifications in endoscopic practice for pediatric patients. Gastrointest Endosc 2008;67(1):1-9.
• Lightdale J, Mahoney L, Levine P, Heard L, Fox V. Safety of endoscopist versus anesthesiologist administered sedation for pediatric endoscopy: in and outside the operating room. Gastrointest Endosc 2006;63:AB94.
• Thakkar K, El-Serag HB, Mattek N, Gilger MA. Complications of pediatric EGD: a 4-year experience in PEDS-CORI. Gastrointest Endosc 2007;65:213-221.
• Hoffman GM, Nowakowski R, Troshynski TJ, Berens RJ, Weisman SJ. Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model. Pediatrics 2002;109:236-243.
• Thompson AM, Wright DJ, Murray W, Ritchie GL, Burton HD, Stonebridge PA. Analysis of 153 deaths after upper gastrointestinal endoscopy: room for improvement? Surg Endosc 2004;18:22-25.
• Malviya S, Voepel-Lewis T, Tait AR. Adverse events and risk factors associated with the sedation of children by nonanesthesiologists. Anesth Analg 1997;85: 1207-1213.
• Hassall E. Should pediatric gastroenterologists be i.v. drug users? J Pediatr Gastroenterol Nutr 1993;16:370-372.
• Becker DE. Pharmacodynamic Considerations for Moderate and Deep Sedation. Anest Prog 2012;59(1):28-42.
• Malviya S, Voepel-Lewis T, Tait AR, Merkel S, Tremper K, Naughton N. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth 2002;88(2):241-245.
• Chung F, Chan V, Ong D. A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth 1995;7(6):500-506.
• Waring JP, Baron TH, Hirota WK, Goldstein JL, Jacobson BC, Leighton JA, et al. American Society for Gastrointestinal Endoscopy, Standards of Practice Committee. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc 2003;58(3):317-322.
• Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002;96:1004-1017.
• Fu ES, Downs JB, Schweiger JW, Miguel RV, Smith RA. Supplemental oxygen impairs detection of hypoventilation by pulse oximetry. Chest 2004;126(5):1552-1558.
• Vargo JJ, Zuccaro G Jr, Dumot JA, Conwell DL, Morrow JB, Shay SS. Automated graphic assessment of respiratory activity is superior to pulse oximetry and visual assessment for the detection of early respiratory depression during therapeutic upper endoscopy. Gastrointest Endosc 2002; 55:826-831.
• Byrne MF, Mitchell RM, Gerke H, Goller S, Stiffler HL, Golioto M, et al. The need for caution with topical anesthesia during endoscopic procedures, as liberal use may result in methemoglobinemia. J Clin Gastroenterol 2004;38(3):225-229.
• 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. Pediatr Anesth 2009;19:784-791.
• Amornyotin S, Aanpreung P. Clinical effectiveness of an anesthesiologist-administered intravenous sedation outside of the main operating room for pediatric upper gastrointestinal endoscopy in Thailand. Int J Pediatr 2010; Article ID 748564, 6 pages.
• Deenadayalu VP, Eid EF, Goff JS, Walker JA, Cohen LB, Heuss LT, et al. Non-anesthesiologist administered propofol sedation for endoscopic procedures: a worldwide safety review. Gastrointest Endosc 2008;67:AB107.
• Motas D, McDermott NB, VanSickle T, Friesen RH. Depth of consciousness and deep sedation attained in children as administered by nonanaesthesiologists in a children’s hospital. Paediatr Anaesth 2004;14:256-260.
• Lightdale JR, Sethna NF, Heard LA, Donovan KM, Fox ViI. A pilot study of end tidal carbon dioxide monitoring using microstream capnography in children undergoing endoscopy with conscious sedation. Gastrointest Endosc 2002;55: AB145.
• Mamula P, Markowitz JE, Neiswender K, Zimmerman A, Wood S, Garofolo Ml, et al. Conscious sedation with midazolam and fentanyl for pediatric endoscopy. Gastrointest Endosc 2003;57: AB121.
• Levis CR, Walker LS, Barnard JA. Children’s knowledge, anticipatory anxiety, procedural distress and recall of esophagogastroduodenosocopy. J Pediatr Gastroenterol Nutr 2002;34:68-72.
• Agostoni M, Fanti L, Gemma M, Pasculli N, Beretta L, Testoni PA. Adverse events during monitored anesthesia care for GI endoscopy: an 8-year experience. Gastrointest Endosc 2011;74(2):266-275.
• Barbi E, Petaros P, Badina L, Pahor T, Giuseppin I, Biasotto E, et al. Deep sedation with propofol for upper gastrointestinal endoscopy in children,administered by specially trained pediatricians: a prospective case series with emphasis on side effects. Endoscopy 2006;38(4):368-375.
• Yıldızdas D, Yapicioglu H, Yilmaz HM. The value of capnography during sedation or sedation/analgesia in pediatric minor procedures. Pediatr Emerg Care 2004;20(3):162-165.