Use of conscious sedation for lower and upper gastrointestinal endoscopic examinations in children, adolescents, and young adults: a twelve-year review.
BACKGROUND
Over the past decade, many pediatric endoscopists have replaced general anesthesia with conscious sedation. Sedation is commonly used to minimize discomfort.


METHODS
To evaluate the safety and efficacy of conscious sedation we reviewed 2711 reports of lower and upper gastrointestinal endoscopic examinations performed in 2026 patients between July 1981 and December 1992.


RESULTS
Intravenous sedation was accomplished using meperidine and diazepam (914 examinations, 35%) or meperidine and midazolam (1427 examinations, 55%). Single agents were used for 83 examinations (3%), and 96 examinations (3.5%) were performed with the patient under general anesthesia. In the lower endoscopy group sedated intravenously (n = 713), the cecum was reached in 82% of examinations. The procedure could not be completed in 17 cases in which patients were uncooperative despite sedation. In the upper endoscopy group sedated intravenously (N = 1653), all but 91 endoscopies were completed to the descending duodenum. Esophagoscopy had been planned in 76% of these procedures. Minor complications occurred in 7 patients (0.3%). This included two episodes of significant oxygen desaturation that responded to oxygen administration and narcotic reversal. A major complication occurred in 1 patient (0.04%) who had a gastric perforation during esophageal dilation over a defective guide wire. There were no deaths, episodes of cardiorespiratory arrest, or pulmonary aspirations in our series. The combined major and minor complication rate was 0.3%.


CONCLUSIONS
Intravenous conscious sedation is safe and effective in children undergoing endoscopic examination of the gastrointestinal tract. Selected patients will require general anesthesia.
Balsells
F
F
Pediatric Gastroenterology and Nutrition, Cleveland Clinic Foundation, OH 44195, USA.
Wyllie
R
R
Kay
M
M
Steffen
R
R
D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D002648:Child; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D003975:Diazepam; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008614:Meperidine; D008874:Midazolam; D012189:Retrospective Studies; D012449:Safety
D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D008614:Meperidine; D003975:Diazepam; D008874:Midazolam