title: Success rate of pneumatic reduction of intussusception with and without sedation.
abstract: BACKGROUND
  Pneumatic reduction of ileocolic intussusception is often performed without sedation. The aim of this study was to evaluate the success rate of pneumatic reduction of intussusception with and without sedation.
  
  
  METHODS
  We conducted a retrospective cohort study in Israel in two tertiary care centers using a similar protocol for pneumatic reduction of intussusception. In one center, patients had pneumatic reduction of intussusception under propofol-based sedation, while in the other, patients had pneumatic reduction of intussusception without any sedation. Children aged 3 months to 8 years who were diagnosed with ileocolic intussusception between January 1, 2008 and July 31, 2015 were included in the study. Multivariable regression was used to adjust for the possible confounders of age, gender, number of cases of intussusception prior to the study period, time period from the beginning of symptoms to emergency department admission (<12 h, >12 h), and time period from emergency department admission to the beginning of pneumatic reduction of intussusception. Secondary outcomes of the study included the proportion of bowel perforations during the procedure, and the proportion of early (within 48 h) recurrence of intussusception.
  
  
  RESULTS
  The sedation and nonsedation cohorts included 124 and 90 patients, respectively. The cohorts were comparable with regard to demographic characteristics, hemodynamic vital signs on admission to the emergency department, blood gases tests during emergency department stay, and time variables prior to reduction of intussusception. Multivariable regression revealed reduction of intussusception success rates of 89.5% and 83.3% for the sedation group and nonsedation group, respectively, with an adjusted odds ratio of 1.2, 95% CI 1.1-5.3. Three sedated patients and 0 nonsedated patients developed bowel perforations during the procedure. Rates of early recurrence of intussusception of sedated patients and nonsedated patients were 5.1% (6/117) and 1.3% (1/79), respectively (P = 0.15, RR = 3.9, 95% CI: 0.47 to 31.81).
  
  
  CONCLUSIONS
  The findings suggest that the pneumatic reduction of intussusception under propofol-based sedation had a slightly higher success rate than the pneumatic reduction of intussusception without sedation; however, the safety of this practice is yet to be determined.
authors.affiliation: Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Oren
authors.initials: O
authors.lastname: Feldman
authors.affiliation: Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Giora
authors.initials: G
authors.lastname: Weiser
authors.affiliation: Pediatric Department B, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Mona
authors.initials: M
authors.lastname: Hanna
authors.affiliation: Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel.
authors.forename: Ori
authors.initials: O
authors.lastname: Devir
authors.affiliation: Pediatric Emergency Department, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Balla
authors.affiliation: University of Calgary, Calgary, AB, Canada.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.affiliation: Pediatric Emergency Unit, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Kozer
authors.affiliation: Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Itai
authors.initials: I
authors.lastname: Shavit
mesh_terms: D018686:Anesthetics, Intravenous; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000628:therapy*; D007223:Infant; D007443:Intussusception / Q000628:therapy*; D007557:Israel; D008297:Male; D015742:Propofol; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol
keywords: anesthesia; child; intravenous agent