Intravenous sedation for pediatric gastrointestinal endoscopy in a developing country.

In book: Gastrointestinal Endoscopy, Chapter: 5, Publisher: InTech
Source: InTech
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Available from: Somchai Amornyotin, Oct 05, 2015
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    ABSTRACT: To determine the adverse event and complication rate for the use of procedural sedation and analgesia for painful procedures and diagnostic imaging studies performed in a pediatric emergency department. This prospective case series was conducted in the ED of a large, urban pediatric teaching hospital. Subjects were patients younger than 21 years seen between August 1997 and July 1998, who required intravenous, intramuscular, oral, rectal, intranasal, or inhalational agents for painful procedures or diagnostic imaging. All patients who underwent procedural sedation and analgesia were continually monitored. Adverse events and complications were recorded. The ED controlled substance log was checked weekly and all sedations were reviewed. Adverse events were defined as follows: oxygen desaturation less than 90%, apnea, stridor, laryngospasm, bronchospasm, cardiovascular instability, paradoxical reactions, emergence reactions, emesis, and aspiration. Complications were defined as adverse events that negatively affected outcome or delayed recovery. Of 1,180 patients who underwent procedural sedation and analgesia in the ED, 27 (2.3%) experienced adverse events, which included oxygen desaturation less than 90% requiring intervention (10 patients) [supplemental oxygen (9), bag-mask ventilation (1)], paradoxical reactions (7), emesis (3), paradoxical reaction and oxygen desaturation requiring supplemental oxygen (2), apnea requiring bag-mask ventilation (1), laryngospasm requiring bag-mask ventilation (1), bradycardia (1), stridor and emesis (1) and oxygen desaturation requiring bag-mask ventilation with subsequent emesis (1). There was no statistically significant difference in mean doses for all procedural sedation and analgesia medication regimens between those children who experienced adverse events and those who did not. No single drug or drug regimen was associated with a higher adverse event rate. In addition, there was no significant difference in the adverse event rate between males and females, among the different ages, or among the different indications for procedural sedation and analgesia. No patient required reversal of sedation with naloxone or flumazenil, endotracheal intubation, or hospital admission because of complications from procedural sedation and analgesia. The adverse event rate for procedural sedation and analgesia performed by pediatric emergency physicians was 2.3% with no serious complications noted.
    Annals of Emergency Medicine 11/1999; 34(4 Pt 1):483-91. DOI:10.1016/S0196-0644(99)80050-X · 4.68 Impact Factor
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    ABSTRACT: Gastrointestinal (GI) endoscopic procedure has become an essential modality for evaluation and treatment of GI diseases. Intravenous (IV) sedation and General Anesthesia (GA) have both been employed to minimize discomfort and provide amnesia. Both these procedures require, at the very least, monitoring of the level of consciousness, pulmonary ventilation, oxygenation and hemodynamics. Although GI endoscopy is considered safe, the procedure has a potential for complications. Increased awareness of the complications associated with sedation during GI endoscopy in children, and involving the anesthesiologists in caring for these children, may be optimal for safety. Belonging to a younger age group, having a higher ASA class and undergoing IV sedation were identified as risk factors for developing complications. Reported adverse events included inadequate sedation, low oxygen saturation, airway obstruction, apnea needing bag mask ventilation, excitement and agitation, hemorrhage and perforation. A complication rate of 1.2% was associated with procedures performed under GA, as compared to 3.7% of complications associated with IV sedation. IV sedation was seen to be independently associated with a cardiopulmonary complication rate 5.3% times higher when compared to GA. GA can therefore be considered safer and more effective in providing comfort and amnesia.
    07/2010; 2(7):257-62. DOI:10.4253/wjge.v2.i7.257
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    ABSTRACT: To measure changes in end-tidal carbon dioxide levels (ETco2) with different sedation/analgesia (midazolam, ketamine, ketamine plus midazolam, midazolam plus fentanyl, and propofol) during pediatric minor surgical procedures and to determine whether there were significant increases in ETco2 with different drugs. We conducted a prospective, randomized, clinical trial of 126 children who needed sedation/analgesia in pediatric intensive care unit in a university hospital. Patients were randomly assigned to 1 of 5 treatment groups. Group K received only intravenous (IV) ketamine 1 mg/kg; group M, IV midazolam 0.15 mg/kg; group KM, IV ketamine 1 mg/kg plus IV midazolam 0.1 mg/kg; group MF, IV midazolam 0.1 mg/kg plus IV fentanyl 2 microg/kg; and group P, IV propofol 2 mg/kg. Side stream, nasal cannula ETco2 tracings were recorded on a capnograph (Capnostat, Marquette). Recordings began prior to the administration of medications and continued throughout the procedure until the patient was fully awake. The primary outcome variable was the difference between peak ETco2 before and during sedation/analgesia. This value was determined by scanning the records for the peak ETco2 averaged over 5 breaths before and after the administration of medications. There was neither any statistical difference between presedation/analgesia and postsedation/analgesia ETco2 levels in the 5 groups (P > 0.05) nor any difference in the first 3 groups between presedation/analgesia, sedation/analgesia, and postsedation/analgesia (K, M, and KM) (P > 0.05). In the midazolam plus fentanyl and propofol groups, mean ETco2 during sedation/analgesia was higher than the mean ETco2 during presedation/analgesia and postsedation/analgesia (P < 0.05). Twenty-one patients (16, 6%) had respiratory depression [hypercarbia (ETco2 > 50 mm Hg) or hypoxia (oxygen saturation > 90% for over 1 minute)], 21 patients (16, 6%) had hypercarbia, and 4 patients (3.2%) had both hypoxia and hypercarbia. One of 4 patients was in the MF group, and 3 were in the P group. Two subjects (8%) in the KM group, 7 (28%) in the MF group, and 13 (52%) in the P group had hypercarbia. This study demonstrated that propofol and midazolam-fentanyl produced a higher incidence of respiratory depression and higher mean ETco2 during sedation/analgesia than presedation and postsedation/analgesia. Capnography can serve as a useful monitoring tool in the evaluation of ventilation during sedation or sedation/analgesia in clinically stable children.
    Pediatric emergency care 03/2004; 20(3):162-5. DOI:10.1097/01.pec.0000117922.65522.26 · 1.05 Impact Factor
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