Insufflation vs intubation during esophagogastroduodenoscopy in children.
OBJECTIVE
We compared adverse airway events during esophagogastroduodenoscopy (EGD) in children managed with insufflation vs intubation.


BACKGROUND
Optimum airway management during EGD in children remains undecided.


METHODS
Following IRB approval and written informed parental consent, children between 1 and 12 years of age presenting for EGD were randomized to airway management with insufflation (Group I), intubation/awake extubation (Group A), or intubation/deep extubation (Group D). All subjects received a standardized anesthetic with sevoflurane in oxygen. Using uniform definitions, airway adverse events during and after EGD recovery were recorded. Categorical data were analysed with Chi-square contingency tables or Fisher's exact test as appropriate.


RESULTS
Analyzable data were available for 415 subjects (Group I: 209; Group A: 101; Group D: 105). Desaturation, laryngospasm, any airway adverse event, and multiple airway adverse events during EGD were significantly more common in subjects in Group I compared to those in Groups A and D. Complaints of sore throat, hoarseness, stridor, and/or dysphagia were more common in subjects in Groups A and D. Analysis of confounders suggested that younger age, obesity, and midazolam premedication were independent predictors of airway adverse events during EGD.


CONCLUSIONS
Insufflation during EGD was associated with a higher incidence of airway adverse events, including desaturation and laryngospasm; intubation during EGD was associated with more frequent complaints related to sore throat. As our results show that insufflation during EGD offers no advantage in terms of operational efficiency and is associated with more airway adverse events, we recommend endotracheal intubation during EGD, especially in patients who are younger, obese, or have received midazolam premedication.
Hoffmann
Clifford O
CO
Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. Cliff.Hoffmann@cchmc.org
Samuels
Paul J
PJ
Beckman
Eileen
E
Hein
Elizabeth A
EA
Shackleford
T Michael
TM
Overbey
Evelyn
E
Berlin
Richard E
RE
Wang
Yu
Y
Nick
Todd G
TG
Gunter
Joel B
JB
D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation; D002648:Child; D002675:Child, Preschool; D016145:Endoscopy, Digestive System / Q000379:methods*; D006801:Humans; D007223:Infant; D007327:Insufflation / Q000009:adverse effects / Q000379:methods*; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011229:Preanesthetic Medication; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome