title: Comparison of different anesthesia techniques during esophagogastroduedenoscopy in children: a randomized trial.
abstract: BACKGROUND
  Esophagogastroduedenoscopy (EGD) in children is usually performed under general anesthesia. Anesthetic goals include minimization of airway complications while maximizing operating room (OR) efficiency. Currently, there is no consensus on which anesthetic technique best meets these goals. We performed a prospective randomized study comparing three different anesthetic techniques.
  
  
  OBJECTIVE
  To evaluate the incidence of respiratory complications (primary aim) and institutional efficiency (secondary aim) among three different anesthetic techniques in children undergoing EGD.
  
  
  METHODS
  Subjects received a standardized inhalation induction of anesthesia followed by randomization to one of the three groups: Group intubated, sevoflurane (IS), Group intubated, propofol (IP), and Group native airway, nonintubated, propofol (NA). Respiratory complications included minor desaturation (SpO2 between 94% and 85%), severe desaturation (SpO2 < 85%), apnea, airway obstruction/laryngospasm, aspiration, and/or inadequate anesthesia during the endoscopy. Evaluation of institutional efficiency was determined by examining the time spent during the different phases of care (anesthesia preparation, procedure, OR stay, recovery, and total perioperative care).
  
  
  RESULTS
  One hundred and seventy-nine children aged 1-12 years (median 7 years; 4.0, 10.0) were enrolled (Group IS N = 60, Group IP N = 59, Group NA N = 61). The incidence of respiratory complications was higher in the Group NA (0.459) vs Group IS (0.033) or Group IP (0.086) (P < 0.0001). The most commonly observed complications were desaturation, inadequate anesthesia, and apnea. There were no differences in institutional efficiency among the three groups.
  
  
  CONCLUSIONS
  Respiratory complications were more common in Group NA. The use of native airway with propofol maintenance during EGD does not offer advantages with respect to respiratory complications or institutional efficiency.
authors.affiliation: Department of Anesthesiology, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Patino
authors.affiliation: Department of Anesthesiology, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Glynn
authors.affiliation: Department of Anesthesiology, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Soberano
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Putnam
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Md Monir
authors.initials: MM
authors.lastname: Hossain
authors.affiliation: Department of Anesthesiology, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Clifford
authors.initials: C
authors.lastname: Hoffmann
authors.affiliation: Department of Anesthesiology, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Samuels
authors.affiliation: Department of Anesthesiology, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kibelbek
authors.affiliation: Department of Anesthesiology, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Gunter
mesh_terms: D058109:Airway Management / Q000379:methods*; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods*; D000769:Anesthesia, Inhalation / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004384:Duodenoscopy; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008738:Methyl Ethers; D015742:Propofol; D011446:Prospective Studies; D000077149:Sevoflurane
chemical_list: D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol
keywords: airway management; airway obstruction; anesthesia, general; anesthesia, inhalation; anesthesia, intravenous; esophagoscopy