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Objective: The main benefits of sedation are to reduce the patient’s anxiety and discomfort, to improve their tolerability. The aim of study was evaluate intravenous sedation for pediatric gastrointestinal endoscopic procedures
Materials and Methods: We analyzed patients’ data, who underwent gastrointestinal endoscopic procedures in our pediatric endoscopy unit, retrospectively. All gastrointestinal endoscopic procedures were performed by a pediatric gastroenterologist and sedations were managed by an anaesthesia team, including two staff anesthesiologists.
Results: During the study period, 530 gastrointestinal endoscopic procedures were performed. 461 (87%) were esophagogastroduodenoscopy, 56 (10.6%) were both esophagogastroduodenoscopy and colonoscopy and 13 (2.5%) were percutaneous endoscopic gastrostomy. Propofol was given all of the patients either as a single drug (6 patients, 1%) or in combinations (77.4% with midazolam; 12.3% with ketamine and 9.2% with fentanyl). Overall adverse event rate due to sedation was 19.6%, but no serious side effects were documented. The most frequent side effects were injection pain (10.4%), and nausea (7.5%). Allergic reactions were experienced in 1.3% patients and resolved with methylprednisolone and antihistaminic medications. Respiratory depression was observed in only two girls (3 and17 years old) and did not need advanced interventions to control the problem. Seven patients’ gastroscopies were interrupted by gastroenterologist due to gastric content in order to prevent vomiting and aspiration.
Conclusions: Intravenous sedation for pediatric gastrointestinal endoscopic procedures can be applied safely and successfully with a trained team and organized endoscopy unit.
Scottish Intercollegiate Guidelines Network. SIGN guideline 58: safe sedation of children undergoing diagnostic and therapeutic procedures. Pediatr Anesth 2008; 18: 11–12.
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology. 1999; 90:896-905.
Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology. 2018; 128:437-479.
Coté CJ, Wilson S. American academy of pediatrics, American academy of pediatric dentistry. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures. Pediatrics. 2019;143:e 20191000.
Gozal D, Drenger B, Levin PD, Kadari A, Gozal Y A. Pediatric sedation/anesthesia program with dedicated care by anesthesiologists and nurses for procedures outside the operating room. J Pediatr. 2004 Jul;145:47-52.
Van Beek EJ, Leroy PL. Safe and effective procedural sedation for gastrointestinal endoscopy in children. J Pediatr Gastroenterol Nutr. 2012;54:171-185.
Orel R, Brecelj J, Dias JA, Romano C, Barros F, Thomson M, Vandenplasl Y. Review on sedation for gastrointestinal tract endoscopy in children by non-anesthesiologists. World J Gastrointest Endosc. 2015;7:895-911.
Oh SH. Sedation in Pediatric Esophagogastroduodenoscopy. Clin Endosc. 2018;51:120-128.
Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med. 2011;57:449–461.
Sajedi P, Habibi B. Comparison of the effects of intravenous premedication: Midazolam, Ketamine, and combination of both on reducing anxiety in pediatric patients before general anesthesia. J Res Pharm Pract. 2015;4:187-92.
Green SM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation in children. Ann Emerg Med. 2004;44:460–471.
Reboso Morales JA, González Miranda F. Ketamina [Ketamine]. Rev Esp Anestesiol Reanim. 1999;46:111-22.
Chidambaran V, Costandi A, D’Mello A. Propofol: a review of its role in pediatric anesthesia and sedation. CNS drugs. 2015; 29: 543–563.
Kim S, Hahn S, Jang M, Choi Y, Hong H, Lee JH, Kim HS. Evaluation of the safety of using propofol for paediatric procedural sedation: A systematic review and meta-analysis. Sci Rep. 2019 22;1:12245.
Borgeat A, Stirnemann HR. AntiemetischeWirkung von Propofol [Antiemetic effect of propofol]. Anaesthesist.1998; 47:918-24.
Naghibi K, Kashefi P, Azarnoush H, Zabihi P. Prevention of postoperative nausea and vomiting with a subhypnotic dose of Propofol in patients undergoing lower abdominal surgery: A prospective, randomized, double-blind study. Adv Biomed Res. 2015;11;4:35.
Khan KJ, Fergani H, Ganguli SC, et al. The Benefit of Fentanyl in Effective Sedation and Quality of Upper Endoscopy: A Double-Blinded Randomized Trial of Fentanyl Added to Midazolam Versus Midazolam Alone for Sedation. J Can Assoc Gastroenterol. 2019; 2:86-90.
Larsen R, Galloway D, WaderaS,Kjar D. Safety of propofol sedation for pediatric outpatient procedures. Clin Pediatr (Phila). 2009;48:819-23.
Disma N, Astuto M, Rizzo G, Rosano G, Naso P, Aprile G, et al.Propofol sedation with fentanyl or midazolam during oesophagogastroduodenoscopy in children. Eur J Anaesthesiol. 2005; 22:848-52.
Paspatis GA, Charoniti I, ManolarakiM,et al.Synergistic sedation with oral midazolam as a premedication and intravenous propofol versus intravenous propofol alone in upper gastrointestinal endoscopies in children: a prospective, randomized study. J Pediatr Gastroenterol Nutr.2006; 43:195-9.
Chandar R, Jagadisan B, Vasudevan A. Propofol-ketamine and propofol-fentanyl combinations for nonanesthetist administered sedation. J Pediatr Gastroenterol Nutr.2015; 60:762-8.
Tringali A, Balassone V, De Angelis P, Landi R. Complications in pediatric endoscopy. Best Pract Res Clin Gastroenterol. 2016;30:825-839.
Pang WW, Huang S, Chung YT, Chang DP, Lin SS, Hong MH. Comparison of intravenous retention of fentanyl and lidocaine on local analgesia in propofol injection pain. Acta Anaesthesiol Sin.1997; 35:217-21.
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;19:784-91.
Barbi E, Petaros P, BadinaL,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;38:368-75.
Bassett KE, Anderson JL, Pribble CG, Günther E. Propofol for procedural sedation in children in the emergency department. Ann Emerg Med 2003; 42: 773–782.
Wehrmann T, Riphaus A. Sedation with propofol for interventional endoscopic procedures: a risk factor analysis. Scand J Gastroenterol. 2008;43(3):368-74. doi: 10.1080/00365520701679181.
Barbi E, Petaros P, Badina L, 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):368-75. doi: 10.1055/s-2005-921194.