Sedation practices in pediatric gastrointestinal endoskopy and related consequences

OBJECTIVES: The aim of this study was to determine the frequency of using sedation, sedation drug regimens, sedation and procedure related complications and effect of these complications on procedure in the pediatric patients who underwent a gastrointestinal system (GIS) endoscopic procedure.PATIENTS AND METHODS: Pediatric patients (one month-18 years) who underwent GIS endoscopic examination between June 2006 and July 2011 in our endoscopy unit were included the study. Medical records of children who undervent GIS endoscopic procedures were rewieved retrospectively for the ages and sex of children, indications for GIS endoscopic examination, the presence of associated diseases, ASA Physical Status Classification, endoscopic and histopathological findings, sedation drug regimens, sedation or procedure related complications and if the procedure were completed properly.RESULTS: Seven-hundred-three endoscopic procedures prformed on 575 children. The age of children was between 1 month and 18 years (mean age: 10.3±4.6). 291 of them (50.6%) were female. Of these 703 procedures, 519 (73.8%) were upper GIS endoscopy, 108 (15.4%) were lower GIS endoscopy, 49 (7%) were upper and lower GIS endoscopy, seven (1%) were rectosigmoidoscopy, one (0.1%) was colonoscopy and double balloon enteroscopy and 2 (0.3%) were double balloon enteroscopy. Percutaneous endoscopic gastrostomy (PEG) was performed or gastrostomy tube changed to 17 (2.4%). Most of our patient?s (95.1%) ASA Physical Status Score were I and II. While 35 (5%) of 703 GIS endoscopic procedures performed for therapeutic purposes, the rest (95%) performed for diagnostic4purposes. The most frequent indication of GIS endoscopic procedure is abdominal pain (46.2%). Other common indications are GIS bleeding (16.5%), search for celiac disease (15.8%) control of eusophageal varises (7.1%), chronic and/or bloody diarrhea (5.5%), suspicion of inflammatory bowel disease (3.3%), performing PEG or changing gastrostomy tube (2.4%) and others (3.1%).Six (0.9%) of 703 GIS endosopic procedures performed without any sedation. All of the other procedures except two, performed with sedation which was admnistered by the anesthesiologist (98.9%). Sedation of these two patients were administered by endoscopist. Propofol based sedation for pediatric GİS endoscopic procedures has been used in our endoscopy unit frequently. The most frequently used drug combination was propofol-midazolam-fentanyl which was used in 582 (83.2%) procedures and secondly propofol-fentanyl which was used in 95 (13.8%) procedures. All of the procedures except 2 (0.3%) were completed safely.Three (0.4%) procedure related complications were detected. One of them was intestinal perforation and two of them were bleeding from the biopsy side. 24 (3.4%) procedures were complicated due to sedation anesthesia. These complications were hypoxia in 11 (1.6%), pain in injection side in eight (1.1%), neusia/vomiting in four (0.6%) and rash in one (0.1%) procedure. The rate of complications (sedation and procedure related) increased significantly with the ASA Physical Status Score (p<0.05; r=0.136).CONCLUSION: In our hospital, pediatric GIS endoscopic procedures have been done with sedation anesthesia (98.9%) out of main operating room in endoscopy unit which is shared with adult gastroenterologists. Propofol based sedation was used in majority of our patients. A small proportion of GIS procedures were complicated due to sedation (3.4%) or procedure itself (0.4%). ASA Physical Status Score and frequency of complications are positively correlated. These results are consistent with the literature.In conclusion, sedation with anesthesiologist provide safe and proper GİS endoscopic procedures in children out of main operating room.Key words: Pediatric, endoscopy, anestesia, sedation, complication