title: Safety of intravenous midazolam and fentanyl for pediatric GI endoscopy: prospective study of 1578 endoscopies.
abstract: BACKGROUND
  Data on safety of intravenous sedation in pediatric GI endoscopy are sparse.
  
  
  OBJECTIVE
  To evaluate safety of intravenous sedation for GI endoscopy.
  
  
  METHODS
  Single-center prospective series of outpatient GI endoscopies performed from February 2003 to February 2004 at The Children's Hospital of Philadelphia. The recorded information included demographic, medication, and adverse event data.
  
  
  METHODS
  A total of 1226 patients were studied.
  
  
  METHODS
  Description of adverse events relating to intravenous sedation.
  
  
  RESULTS
  A total of 2635 endoscopies were performed, of which 1717 were outpatient procedures with the patient under intravenous sedation. Sedation data were available on 1578 procedures (92%, M/F 674/552): 758 esophagogastroduodenoscopies (EGD) alone, 116 colonoscopies (COL) alone, and 352 combined EGD and COL. The median dose of fentanyl was 2.77 microg/kg (SD 0.97, range 0-6.73), and of midazolam was 0.11 mg/kg (SD 0.06, range 0-0.39). The mean recovery time was 118 minutes (SD 47.3, range 31-375). Ten patients (0.8%) failed intravenous sedation. Serious adverse events (apnea) were noted in 2 patients (0.2%). Mild or moderate adverse events included desaturation below 92% for less than 20 seconds (100 patients, 9%), vomiting (64 patients, 5%), agitation (15 patients, 1%), desaturation below 92% for greater than 20 seconds (12 patients, 0.7%), and rash (8 patients, 0.7%). No cardiopulmonary resuscitation or sedation reversal was necessary. No patients required hospitalization. Patients younger than 6 years were more likely to develop respiratory adverse event (P < .01).
  
  
  CONCLUSIONS
  Intravenous sedation with midazolam and fentanyl is safe for pediatric GI endoscopy. Serious adverse events are rare and no patient required hospitalization.
authors.affiliation: Division of GI and Nutrition, The Children's Hospital of Philadelphia, Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Petar
authors.initials: P
authors.lastname: Mamula
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Markowitz
authors.forename: Kristin
authors.initials: K
authors.lastname: Neiswender
authors.forename: Ann
authors.initials: A
authors.lastname: Zimmerman
authors.forename: Stephanie
authors.initials: S
authors.lastname: Wood
authors.forename: Michael
authors.initials: M
authors.lastname: Garofolo
authors.forename: Megan
authors.initials: M
authors.lastname: Nieberle
authors.forename: Andria
authors.initials: A
authors.lastname: Trautwein
authors.forename: Susan
authors.initials: S
authors.lastname: Lombardi
authors.forename: Lynn
authors.initials: L
authors.lastname: Sargent-Harkins
authors.forename: Greta
authors.initials: G
authors.lastname: Lachewitz
authors.forename: Lisa
authors.initials: L
authors.lastname: Farace
authors.forename: Verita
authors.initials: V
authors.lastname: Morgan
authors.forename: Anita
authors.initials: A
authors.lastname: Puma
authors.forename: Scott D
authors.initials: SD
authors.lastname: Cook-Sather
authors.forename: Chris A
authors.initials: CA
authors.lastname: Liacouras
mesh_terms: D000293:Adolescent; D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl