title: Adverse events related to gastrointestinal endoscopic procedures in pediatric patients under anesthesia care and a predictive risk model (AEGEP Study).
abstract: BACKGROUND
  Multiple studies have analyzed perioperative factors related to adverse events (AEs) in children who require gastrointestinal endoscopic procedures (GEP) in settings where deep sedation is the preferred anesthetic technique over general anesthesia (GA) but not for the opposite case.
  
  
  METHODS
  We reviewed our anesthesia institutional database, seeking children less than 12 years who underwent GEP over a 5-year period. A logistic regression was used to determine significant associations between preoperative conditions, characteristics of the procedure, airway management, anesthetic approaches and the presence of serious and non-serious AEs.
  
  
  RESULTS
  GA was preferred over deep sedation [77.8% vs. 22.2% in 2178 GEP under anesthesia care (n=1742)]. We found 96 AEs reported in 77 patients, including hypoxemia (1.82%), bronchospasm (1.14%) and laryngospasm (0.91%) as the most frequent. There were 2 cases of severe bradycardia related to laryngospasm/hypoxemia and a case of aspiration resulting in unplanned hospitalization, but there were no cases of intra- or postoperative deaths. Final predictive model for perioperative AEs included age <1 year, upper respiratory tract infections (URTI) <1 week prior to the procedure and low weight for the age (LWA) as independent risk factors and ventilation by facial mask as a protector against these events (p<0.05).
  
  
  CONCLUSIONS
  AEs are infrequent and severe ones are remote in a setting where AG is preferred over deep sedation. Ventilatory AEs are the most frequent and depend on biometrical and comorbid conditions more than anesthetic drugs chosen. Age <1 year, history of URTI in the week prior to the procedure and LWA work as independent risk factors for AEs in these patients.
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia. Electronic address: fredyariza@hotmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Ariza
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia.
authors.forename: D
authors.initials: D
authors.lastname: Montilla-Coral
authors.affiliation: Department of Pediatric Surgery, Fundación Valle del Lili, Cali, Colombia.
authors.forename: O
authors.initials: O
authors.lastname: Franco
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia.
authors.forename: L F
authors.initials: LF
authors.lastname: González
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia.
authors.forename: L C
authors.initials: LC
authors.lastname: Lozano
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia.
authors.forename: A M
authors.initials: AM
authors.lastname: Torres
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia.
authors.forename: J
authors.initials: J
authors.lastname: Jordán
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia.
authors.forename: L F
authors.initials: LF
authors.lastname: Blanco
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia.
authors.forename: L
authors.initials: L
authors.lastname: Suárez
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia.
authors.forename: G
authors.initials: G
authors.lastname: Cruz
authors.affiliation: Clinical Research Unit, Fundación Valle del Lili, Cali, Colombia.
authors.forename: M
authors.initials: M
authors.lastname: Cepeda
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects*; D001919:Bradycardia / Q000209:etiology; D001986:Bronchial Spasm / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D054810:Deep Sedation; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007826:Laryngismus / Q000209:etiology; D008297:Male; D008397:Masks; D008962:Models, Theoretical; D011595:Psychomotor Agitation / Q000209:etiology; D012121:Respiration, Artificial; D012141:Respiratory Tract Infections / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk
keywords: Adverse events; Anestesia general; Anestesia pediátrica; Deep sedation; Endoscopia; Endoscopy; Endoscopy procedures; Eventos adversos; General anesthesia; Pediatric anesthesia; Sedación profunda