Respiratory adverse events during upper digestive endoscopies in children under ketamine sedation.
There is no evidence of the need for oxygen supplementation during upper digestive endoscopies under ketamine sedation in children, and the latest recommendations specifically state that it is not mandatory for the procedure. The aim of our study is to assess the incidence of respiratory adverse events during upper digestive endoscopies in children under Ketamine sedation when performed without oxygen supplementation, in accordance with the latest recommendations.



Eighty-eight children undergoing ketamine sedation for programmed upper digestive endoscopy at our Pediatric Intensive Care Unit were included. Patients needing other sedative agents different from ketamine were excluded. No patients received previous oxygen therapy. Suction equipment, oxygen, a bag-valve-mask, and age-appropriate equipment for advanced airway management were immediately available. The primary outcome measure was the incidence of desaturation episodes (i.e. FiO<inf>2</inf> below 90% requiring an intervention).



Fifty-five patients (62.5%) presented a desaturation episode during the procedure. Most desaturation episodes occurred during the endoscope introduction (78.2%), and 5 episodes were previous to the endoscope introduction (minute 0). Around sixty percent of patients (58.9%) required oxygen therapy and four patients required bag-mask ventilation. Once oxygen therapy was initiated, 34 patients (70.5%) required it during the complete procedure or part of it.



Desaturation episodes occur frequently early on in the procedure. Our data suggest that the role of oxygen supplementation prior to, and during upper digestive endoscopies under ketamine sedation in children should be thoroughly assessed for future recommendations.
Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain - carlosflogon@gmail.com.
José C
JC
Flores-González
Department of Mother and Child Health, University of Cadiz, Cadiz, Spain.|Department of Radiology, University of Cadiz, Cadiz, Spain.
Alfonso M
AM
Lechuga-Sancho
Unit of Clinical Farmacology, Puerta del Mar University Hospital, Cadiz, Spain.
Mónica
M
Saldaña Valderas
Research Unit, Puerta del Mar University Hospital, Cadiz, Spain.
Gema
G
Jimenez Gomez
Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain.
María D
MD
Cruzado García
Unit of Pediatric Gastroenterology, Puerta del Mar University Hospital, Cadiz, Spain.
Cristina
C
Pérez Aragón
Unit of Pediatric Gastroenterology, Puerta del Mar University Hospital, Cadiz, Spain.
Jose A
JA
Blanca García
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000009:adverse effects*; D054810:Deep Sedation / Q000009:adverse effects*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D007649:Ketamine / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D011446:Prospective Studies; D012120:Respiration Disorders / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy
D006993:Hypnotics and Sedatives; D007649:Ketamine