Experience of intravenous sedation for pediatric gastrointestinal endoscopy in a large tertiary referral center in a developing country.
BACKGROUND
The aim of this study was to evaluate the clinical efficacy of intravenous sedation for pediatric gastrointestinal endoscopy (GIE) at a tertiary care teaching hospital in a developing country.


METHODS
We undertook a retrospective review of the sedation service records of pediatric patients who underwent GIE. All endoscopies were performed by a pediatric gastroenterologist. All of the sedation was administered by staff anesthesiologist or anesthetic personnel in the gastroenterology procedure room.


RESULTS
Sedation was provided for 222 procedures in 214 patients ranged in age from younger than 1 to 17 years and in weight from 2.7 to 80.0 kg. Intravenous sedation was provided in 176 patients (82.2%). Of these patients, 185 procedures were performed and reviewed, with 152 (82.2%) procedures were esophagogastroduodenoscopy (EGD) alone, 14 (7.6%) procedures were colonoscopy alone, 18 (9.7%) procedures were EGD and colonoscopy, and one procedure was endoscopic ultrasonography (EUS). Most common indications of the procedure were screening for esophageal varices (25.2%), abdominal pain (15.9%), history of upper gastrointestinal hemorrhage (13.6%), and unexplained anemia (10.3%). The majority of preanesthetic problems were hematologic disease, anemia (38.2%); liver disease, cirrhosis (13.5%); and electrolyte imbalance (13.5%). Propofol (94.0%), fentanyl (87.0%), and midazolam (67.8%) were frequently used. The mean dose of propofol was 7.8 +/- 4.1 mg.kg(-1).h(-1), fentanyl 2.3 +/- 1.1 mcg.kg(-1).h(-1), and midazolam 0.1 +/- 0.1 mg.kg(-1).h(-1). Most of them were used in combination. The combination of propofol, fentanyl, and midazolam was commonly employed (46.4%). The mean sedation time of all procedures was 28.2 min and was different according to procedure type. Complications occurred infrequently (13.5%) and were medication or airway related. All complications were easily treated, with no adverse sequelae. Intravenous sedation was successful except for one patient who required general anesthesia. However, all procedures were completed successfully.


CONCLUSIONS
In the setting of the developing country, intravenous sedation for pediatric GIE by trained anesthetic personnel with appropriate monitoring was safe and effective. Serious adverse events were rare in our population.
Amornyotin
Somchai
S
Department of Anesthesiology, Mahidol University, Bangkok 10700, Thailand. sisam@mahidol.ac.th
Aanpreung
Prapun
P
Prakarnrattana
Ungkab
U
Chalayonnavin
Wiyada
W
Chatchawankitkul
Sukanda
S
Srikureja
Wichit
W
D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000009:adverse effects*; D003906:Developing Countries; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D004945:Esophagoscopy / Q000706:statistics & numerical data; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D013785:Thailand; D016896:Treatment Outcome
D000700:Analgesics; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D007649:Ketamine; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol