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Yuan C, Wang C, Wu J, Gao N, Li K, Li Y, Huang X, Huang W, Hu Z. Continuous infusion of lidocaine in pediatric colonoscopy: A randomized double-blind placebo-controlled study. Saudi J Gastroenterol 2021; 28:54-59. [PMID: 34806658 PMCID: PMC8919925 DOI: 10.4103/sjg.sjg_275_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Propofol is commonly used for providing procedural sedation during pediatric colonoscopy. Intravenous (i.v.) lidocaine can mitigate visceral pain and reduce propofol requirements during surgery. The aim of this study is to investigate the effect of i.v. lidocaine on perioperative propofol and sufentanil dose, pulse oxygen saturation, postoperative pain score, and recovery time during pediatric colonoscopy. METHODS We designed a randomized, double-blind, placebo-controlled study and enrolled 40 children aged from 3 to 10 years who underwent colonoscopy. After titration of propofol to achieve unconsciousness, the patients were given i.v. lidocaine (1.5 mg/kg later 2 mg/kg/hour) or the same volume of saline. Sedation was standardized and combined propofol with sufentanil. The primary outcome variables were intraoperative propofol and sufentanil requirements, and the number of oxygen desaturation episodes. Secondary outcome variables were recovery time after colonoscopy and post-colonoscopy pain. RESULTS Lidocaine infusion resulted in a significant reduction in propofol requirements: (median (quartile) 1.8 (1.5-2.0) vs. 3.0 (2.8-3.3) mg/kg respectively; P < 0.001) and sufentanil requirements: (median (quartile) 0.06 (0.05-0.08) vs. 0.1 (0.1-0.1) μg/kg respectively; P < 0.001). The number of subjects who experienced oxygen desaturation below 95% in the lidocaine group was also significantly less than that in the control group: 1 vs. 6 (P = 0.04). The mean (SD) recovery time was significantly shorter in the lidocaine group: (19.2 (2.6) vs. 13.3 (2.6) min respectively; P < 0.001). There was no significant difference in post-colonoscopy pain. CONCLUSION Continuous infusion of lidocaine resulted in reduction of propofol and sufentanil requirements, recovery time, and risk of hypoxemia during pediatric colonoscopy.
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Affiliation(s)
- Chao Yuan
- Department of Anesthesiology, Guangdong Women and Children Hospital, China
| | - Chengli Wang
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China
| | - Jiayao Wu
- Department of Anesthesiology, Guangdong Women and Children Hospital, China
| | - Ningyang Gao
- Department of Anesthesiology, Guangdong Women and Children Hospital, China
| | - Kunwei Li
- Department of Anesthesiology, Guangdong Women and Children Hospital, China
| | - Yongle Li
- Department of Anesthesiology, Guangdong Women and Children Hospital, China
| | - Xizhao Huang
- Department of Anesthesiology, Guangdong Women and Children Hospital, China
| | - Wei Huang
- Department of Anesthesiology, Guangdong Women and Children Hospital, China
| | - Zurong Hu
- Department of Anesthesiology, Guangdong Women and Children Hospital, China,Address for correspondence: Dr. Zurong Hu, Department of Anesthesiology, Guangdong Women and Children Hospital, Guangzhou, China, No. 13 Guangyuan West Road, Guangzhou, 510010, China. E-mail:
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Mian MN, Alwasiah N, Savitz A. The use and safety of intramuscular midazolam during in-office botulinum toxin injections in pediatric patients. J Pediatr Rehabil Med 2021; 14:213-218. [PMID: 33896852 DOI: 10.3233/prm-190629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Pediatric outpatient procedures can be traumatic experiences for patients. This retrospective study, evaluates intramuscular midazolam as a safe option for anxiolysis during spasticity management injections. METHODS We performed a retrospective chart review of 72 patients from a Tertiary Pediatric Hospital Outpatient Clinic. One hundred and twenty injections were administered over two years by a single practitioner. Comorbidities included asthma, sleep apnea, chronic obstructive disease, and epilepsy. Duration of sedation, safety of midazolam as determined through the use of the REACT (Respiration, Energy, Alertness, Circulation, Temperature) score, and frequency of side effects (prolonged sedation, breakthrough crying, medication reversal, and emergent evaluation) were recorded. A student's t test evaluated the relationship between the above comorbidities and duration of sedation. RESULTS The average duration of sedation was 29 minutes (95% CI 26.51-31.35) with an average dose of midazolam of 0.20 mg/kg (95% CI 0.9-0.21). None of the subjects required medication reversal or emergent evaluation. 39% of the patients had prolonged sedation (> 30 minutes after medication administration), 22% had breakthrough crying, and 0% had respiratory events requiring oxygen, intubation or an emergency evaluation. No statistical significance found between the comorbidities and duration of sedation. CONCLUSION Intramuscular midazolam is a possible effective anxiolytic medication strategy for outpatient pediatric injections. Additional studies are needed to ensure its safety and efficacy.
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Affiliation(s)
- Mariam N Mian
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Nadia Alwasiah
- Department of Rehabilitation and Physiotherapy, American Hospital Dubai, Dubai, United Arab Emirates
| | - Ariel Savitz
- Department of Orthopedic Medicine, Tufts Medical Center, Boston, MA, USA
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Narula N, Masood S, Shojaee S, McGuinness B, Sabeti S, Buchan A. Safety of Propofol versus Nonpropofol-Based Sedation in Children Undergoing Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis. Gastroenterol Res Pract 2018; 2018:6501215. [PMID: 30210535 PMCID: PMC6126059 DOI: 10.1155/2018/6501215] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The majority of children who undergo gastrointestinal (GI) endoscopy require anesthesia or procedural sedation for comfort, cooperation, and procedure efficiency. The safety profile of propofol is not well established in children but has been studied in the literature. OBJECTIVE The aim of this study is to evaluate and compare the safety of propofol-only sedation for GI endoscopy procedures to other anesthetic regimes in the pediatric population. METHODS A search was conducted in the MEDLINE, Embase, and Cochrane Library databases. Randomized clinical trials and prospective cohorts were included in the study. RESULTS No significant difference was noted in total complications between the two cohorts with a pooled OR of 1.31 (95% CI: 0.57-3.04, chi2 = 0.053, I2 = 54.31%). The pooled rate of complications in the studies was 23.4% for those receiving propofol only and 18.2% for those receiving other anesthetic regimens. Sensitivity analysis was performed removing a study with a very different control comparison compared to the rest of the studies included. Once excluded, there was minimal heterogeneity in the remaining studies and a significant difference in overall complications was detected, with more complications seen in the propofol-only group compared to the other anesthetic groups (OR 1.87, 95% CI 1.09-3.20). CONCLUSION Significantly higher incidence of cardiorespiratory complications was noted in the propofol-only versus other anesthetic regimens in pediatric patients undergoing GI endoscopy in this meta-analysis. However, the overall quality of the evidence is very low. HOW TO APPLY THIS KNOWLEDGE FOR ROUTINE CLINICAL PRACTICE Clinicians providing sedation to a pediatric population for GI endoscopy should consider there may be increased risks when using a propofol-only regimen, but further study is needed.
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Affiliation(s)
- Neeraj Narula
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Sameer Masood
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Samira Shojaee
- Department of Medicine (Division of Pulmonary and Critical Care Medicine), Virginia Commonwealth University, Richmond, VA, USA
| | - Brandon McGuinness
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Saama Sabeti
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Arianne Buchan
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
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Yoshioka S, Takedatsu H, Fukunaga S, Kuwaki K, Yamasaki H, Yamauchi R, Mori A, Kawano H, Yanagi T, Mizuochi T, Ushijima K, Mitsuyama K, Tsuruta O, Torimura T. Study to determine guidelines for pediatric colonoscopy. World J Gastroenterol 2017; 23:5773-5779. [PMID: 28883703 PMCID: PMC5569292 DOI: 10.3748/wjg.v23.i31.5773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/23/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigated characteristics, diagnosis, bowel-cleansing preparation, sedation, and colonoscope length and diameter in Japanese pediatric patients receiving total colonoscopy.
METHODS The present study evaluated consecutive patients aged ≤ 15 years who had undergone their first colonoscopy in Kurume University between January 2007 and February 2015. Data were retrospectively analyzed. We identified 110 pediatric patients who had undergone colonoscopy that had reached the cecum, allowing the observation of the total colon.
RESULTS Hematochezia, abdominal pain, and diarrhea were the most common symptoms. For bowel-cleansing preparation, pediatric patients aged ≤ 12 years were treated with magnesium citrate, and patients aged 13-15 years were treated with polyethylene glycol 4000. For sedation, thiamylal with pentazocine, which has an analgesic effect, was used in patients aged ≤ 6 years, and midazolam with pentazocine was used in patients aged ≥ 7 years. Regarding the choice of endoscope, short and thin endoscopes were selected for younger patients, particularly patients aged ≤ 3 years. Positive diagnoses were made in 78 patients (70.9%). Inflammatory bowel disease (n = 49, 44.5%), including ulcerative colitis (n = 37, 33.6%) and Crohn’s disease (n = 12, 10.9%), was the most common diagnosis.
CONCLUSION Colonoscopy offers a high diagnostic capability for pediatric patients with gastrointestinal symptoms. The selection of appropriate management the performance of colonoscopy is important in pediatric patients.
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Affiliation(s)
- Shinichiro Yoshioka
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Asahi-machi Kurume, Fukuoka 830-0011, Japan
| | - Hidetoshi Takedatsu
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka 814-0180, Japan
| | - Shuhei Fukunaga
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Asahi-machi Kurume, Fukuoka 830-0011, Japan
| | - Kotaro Kuwaki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Asahi-machi Kurume, Fukuoka 830-0011, Japan
| | - Hiroshi Yamasaki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Asahi-machi Kurume, Fukuoka 830-0011, Japan
| | - Ryosuke Yamauchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Asahi-machi Kurume, Fukuoka 830-0011, Japan
| | - Atsushi Mori
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Asahi-machi Kurume, Fukuoka 830-0011, Japan
| | - Hiroshi Kawano
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Asahi-machi Kurume, Fukuoka 830-0011, Japan
| | - Tadahiro Yanagi
- Department of Pediatrics and Child Health Kurume University School of Medicine, Asahi-machi Kurume, Fukuoka 830-0011, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health Kurume University School of Medicine, Asahi-machi Kurume, Fukuoka 830-0011, Japan
| | - Kosuke Ushijima
- Department of Pediatrics and Child Health Kurume University School of Medicine, Asahi-machi Kurume, Fukuoka 830-0011, Japan
| | - Keiichi Mitsuyama
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Asahi-machi Kurume, Fukuoka 830-0011, Japan
| | - Osamu Tsuruta
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Asahi-machi Kurume, Fukuoka 830-0011, Japan
| | - Takuji Torimura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Asahi-machi Kurume, Fukuoka 830-0011, Japan
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Ito Y, Isayama H, Nakai Y, Umefune G, Sato T, Nakahara S, Suwa J, Kato K, Nakata R. Successful Endosonography-Guided Drainage of an Intra-Abdominal Abscess in a 1-Year-Old Infant. Gut Liver 2016; 10:483-5. [PMID: 27114437 PMCID: PMC4849704 DOI: 10.5009/gnl15381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Endoscopic ultrasound (EUS)-guided intervention has been established as a safe, effective and minimally invasive procedure for various diseases in adults, but there have been limited reports in pediatric patients. Herein, we report our experience with successful EUS-guided drainage of an intra-abdominal abscess in a 1-year-old infant concomitant with disseminated intravascular coagulation. The abscess was punctured via the stomach using a standard, convex-type echoendoscope, and the patient’s condition improved after naso-cystic catheter placement. Although the clinical course was complicated by delayed hemorrhage from the puncture site, the bleeding was successfully managed by endoscopic hemostasis using a standard forward-viewing endoscope.
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Affiliation(s)
- Yukiko Ito
- Department of Gastroenterology, Red Cross Medical Center, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Red Cross Medical Center, Tokyo, Japan.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Red Cross Medical Center, Tokyo, Japan.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gyoutane Umefune
- Department of Gastroenterology, Red Cross Medical Center, Tokyo, Japan
| | - Tatsuya Sato
- Department of Gastroenterology, Red Cross Medical Center, Tokyo, Japan
| | - Saori Nakahara
- Department of Pediatric Surgery, Red Cross Medical Center, Tokyo, Japan
| | - Junko Suwa
- Department of Anesthesiology, Red Cross Medical Center, Tokyo, Japan
| | - Keiichi Kato
- Department of Anesthesiology, Red Cross Medical Center, Tokyo, Japan
| | - Ryo Nakata
- Department of Gastroenterology, Red Cross Medical Center, Tokyo, Japan
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Biber JL, Allareddy V, Allareddy V, Gallagher SM, Couloures KG, Speicher DG, Cravero JP, Stormorken AG. Prevalence and Predictors of Adverse Events during Procedural Sedation Anesthesia-Outside the Operating Room for Esophagogastroduodenoscopy and Colonoscopy in Children: Age Is an Independent Predictor of Outcomes. Pediatr Crit Care Med 2015. [PMID: 26218257 DOI: 10.1097/pcc.0000000000000504] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Procedural sedation/anesthesia outside the operating room for a variety of procedures is well described with an overall low adverse event rate in certain settings. Adverse event associated with procedural sedation/anesthesia outside the operating room for gastrointestinal procedures have been described, albeit in small, single-center studies with wide variance in outcomes. Predictors of such outcomes are unclear. We aimed to estimate the prevalence of adverse event in children undergoing procedural sedation/anesthesia outside the operating room for esophagogastroduodenoscopy, colonoscopy, or both to identify predictors of adverse event. DESIGN/SETTING/PATIENTS Retrospective analysis of Pediatric Sedation Research Consortium database, a large data repository of pediatric patients aged 21 years old or younger undergoing procedural sedation/anesthesia outside the operating room during September 2007 to November 2011. Twenty-two of the 40 centers provided data pertaining to the procedure of interest. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Primary outcome variable is any adverse event. Independent variables include: age (five groups), sex, American Societyof Anaesthesiologists status, procedure (esophagogastroduodenoscopy, colonoscopy, or both), provider responsible, medication used, location, and presence of coexisting medical conditions. Descriptive statistics used to summarize the data. Using multivariablelogistic regression model, odds ratio, 95% CI) were computed. A total of 12,030 procedures were performed (esophagogastroduodenoscopy, 7,970; colonoscopy, 1,378; and both, 2,682). A total of 96.9% of patients received propofol. Eighty-three percent were performed in a sedation unit. Prevalence of adverse event was 4.8%. The most common adverse event were persistent desaturations (1.5%), airway obstruction (1%), cough (0.9%), and laryngospasm (0.6%). No deaths or CPR occurred. Infants and children aged 5 years old or younger had a higher adverse event rate than older children (15.8%, 7.8% vs 4%). Regression analysis revealed age 5 years old or younger, American Society of Anaesthesiologists greater than or equal to 2, esophagogastroduodenoscopy ± colonoscopy, and coexisting medical conditions of obesity and lower airway disease were independent predictors of higher adverse event. CONCLUSIONS Overall prevalence of any adverse event was 4.8%. Independent predictors of adverse events in procedural sedation/anesthesia outside the operating room in pediatric esophagogastroduodenoscopy/colonoscopy onoscopy were identified. Recognition of such risk factors may enable optimization of procedural sedation.
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Affiliation(s)
- Jennifer L Biber
- 1Department of Pediatric Critical Care Medicine, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH. 2Department of Orthodontics, School of Dental Medicine, University of Iowa, Iowa City, IA. 3Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH. 4Department of Pediatric Critical Care Medicine, Yale New Haven Hospital, Yale University, New Haven, CT. 5Children's Hospital Boston, Harvard University, Cambridge, MA
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Amornyotin S. Registered nurse-administered sedation for gastrointestinal endoscopic procedure. World J Gastrointest Endosc 2015; 7:769-76. [PMID: 26191341 PMCID: PMC4501967 DOI: 10.4253/wjge.v7.i8.769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/24/2014] [Accepted: 05/05/2015] [Indexed: 02/05/2023] Open
Abstract
The rising use of nonanesthesiologist-administered sedation for gastrointestinal endoscopy has clinical significances. Most endoscopic patients require some forms of sedation and/or anesthesia. The goals of this sedation are to guard the patient's safety, minimize physical discomfort, to control behavior and to diminish psychological responses. Generally, moderate sedation for these procedures has been offered by the non-anesthesiologist by using benzodiazepines and/or opioids. Anesthesiologists and non-anesthesiologist personnel will need to work together for these challenges and for safety of the patients. The sedation training courses including clinical skills and knowledge are necessary for the registered nurses to facilitate the patient safety and the successful procedure. However, appropriate patient selection and preparation, adequate monitoring and regular training will ensure that the use of nurse-administered sedation is a feasible and safe technique for gastrointestinal endoscopic procedures.
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Wiskin A, Smith J, Wan S, Nally M, Shah N. Propofol anaesthesia is safe in children with food allergy undergoing endoscopy. Br J Anaesth 2015; 115:145-146. [DOI: 10.1093/bja/aev177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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The safety of propofol sedation for elective nonintubated esophagogastroduodenoscopy in pediatric patients. Pediatr Crit Care Med 2014; 15:e261-9. [PMID: 24849145 DOI: 10.1097/pcc.0000000000000147] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To evaluate the safety of deep sedation provided by pediatric intensivists for elective nonintubated esophagogastroduodenoscopy. DESIGN Retrospective observational study. SETTING The sedation program at the Helen DeVos Children's Hospital. PATIENTS A 4-year retrospective analysis was done on all outpatient elective pediatric esophagogastroduodenoscopy procedures performed in an intensivist run sedation program. Safety was examined by reviewing the occurrence of minor and major adverse effects during esophagogastroduodenoscopy sedation. Interventions were studied and reported. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS During the study period, 12,447 sedations were performed by the pediatric sedation program for various procedures. Two thousand one hundred forty-seven patients received 2,325 sedations (18.6%) for esophagogastroduodenoscopies performed for various indications. During the same time period, 53 (one for every 40 esophagogastroduodenoscopy sedations) were screened, found unsuitable for nonintubated sedation, and referred for general anesthesia. There were 2,254 sedations with propofol, 65 methohexital, five ketamine, and one fentanyl/midazolam sedation. Propofol sedation proved safe with a 2.1% prevalence of minor adverse events and no major events. Methohexital, on the other hand, had higher rate (p < 0.001) of minor events and one patient developed an anaphylactic reaction to its use. Regression analysis showed that other sedative agents were 8.6 times more likely to be associated with complications than propofol (odds ratio, 8.6; 95% CI, 4.1-18.2; p < 0.001). CONCLUSIONS This study demonstrates that deep sedation for elective esophagogastroduodenoscopies can be provided safely in the appropriately screened patient by nonanesthesiologist physicians in a sedation program. These data suggest that propofol is a safe and effective agent for esophagogastroduodenoscopy sedation.
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Ariza F, Montilla-Coral D, Franco O, González LF, Lozano LC, Torres AM, Jordán J, Blanco LF, Suárez L, Cruz G, Cepeda M. Adverse events related to gastrointestinal endoscopic procedures in pediatric patients under anesthesia care and a predictive risk model (AEGEP Study). ACTA ACUST UNITED AC 2014; 61:362-8. [PMID: 24661725 DOI: 10.1016/j.redar.2014.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 12/20/2013] [Accepted: 01/20/2014] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- F Ariza
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia.
| | - D Montilla-Coral
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - O Franco
- Department of Pediatric Surgery, Fundación Valle del Lili, Cali, Colombia
| | - L F González
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - L C Lozano
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - A M Torres
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - J Jordán
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - L F Blanco
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - L Suárez
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - G Cruz
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - M Cepeda
- Clinical Research Unit, Fundación Valle del Lili, Cali, Colombia
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Abstract
The volume of pediatric invasive and noninvasive procedures outside the operating room continues to increase. The acuity and complexity of patient clinical condition has resulted in the expansion of the anesthesiologist's role in remote sites. The anesthesia provider must ensure patient safety by assuring appropriate patient preparation, having available required equipment for monitoring and rescue, planning careful sedation/anesthesia management, continuing vigilance and observation into the recovery phase, and requiring strict discharge criteria. A quality improvement program for the department of anesthesiology should review anesthetic and sedation outcomes of patients both inside and outside the operating room.
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Affiliation(s)
- Katrin Campbell
- Division of Sedation, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Suite A300, Houston, TX 77030, USA
| | - Laura Torres
- Department of Pediatrics, Sedation Oversight Committee, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Suite A300, Houston, TX 77030, USA
| | - Stephen Stayer
- Pediatric Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Suite A300, Houston, TX 77030, USA.
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Lim SH, Kim MJ, Lee MJ. Use of animated cartoons with children's songs to increase compliance with ultrasonography in young children. Yonsei Med J 2013; 54:1533-7. [PMID: 24142662 PMCID: PMC3809887 DOI: 10.3349/ymj.2013.54.6.1533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the effect of animated cartoons with children's songs to increase compliance with ultrasonography (US) examination in young children. MATERIALS AND METHODS Animated cartoons with children's songs viewed on a cell phone were played just before the start of US examination when pediatric patients were agitated or irritable. The effect of this method was evaluated for initial responses and sustained responses (grade 0, no response; 1, partial response; and 2, good response). Site of US examination, scan duration, and the helpfulness of this method (0, useless; 1, partially helpful; and 2, very helpful) were also recorded. RESULTS Among 464 pediatric patients who underwent US during the study period, 88 children (19%) needed to be calmed (67 abdominal and 21 other parts of the body). All subjects were less than five years of age (mean 1.5 years), except for four patients with mental retardation. Scan duration was less than 5 minutes in almost all examinations. Five children refused to watch the cartoon. Initial responses were good in 75 and partial in eight children. Sustained responses were good in 70 and partial in 12 children. The cartoons were very helpful in 73 (83%) and partially helpful in nine (10%) children. The effect of watching the cartoon did not change with sex, age (less or more than one year), or site of examination. CONCLUSION Animated cartoons with children's songs viewed on a cell phone were helpful (93%) in increasing compliance with US examination in young children of both the abdomen and other parts.
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Affiliation(s)
- Sok Hwan Lim
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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Amornyotin S. Sedation and monitoring for gastrointestinal endoscopy. World J Gastrointest Endosc 2013; 5:47-55. [PMID: 23424050 PMCID: PMC3574612 DOI: 10.4253/wjge.v5.i2.47] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 07/11/2012] [Accepted: 12/01/2012] [Indexed: 02/05/2023] Open
Abstract
The safe sedation of patients for diagnostic or therapeutic procedures requires a combination of properly trained physicians and suitable facilities. Additionally, appropriate selection and preparation of patients, suitable sedative technique, application of drugs, adequate monitoring, and proper recovery of patients is essential. The goal of procedural sedation is the safe and effective control of pain and anxiety as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation practices for gastrointestinal endoscopy (GIE) vary widely. The majority of GIE patients are ambulatory cases. Most of this procedure requires a short time. So, short acting, rapid onset drugs with little adverse effects and improved safety profiles are commonly used. The present review focuses on commonly used regimens and monitoring practices in GIE sedation. This article is to discuss the decision making process used to determine appropriate pre-sedation assessment, monitoring, drug selection, dose of sedative agents, sedation endpoint and post-sedation care. It also reviews the current status of sedation and monitoring for GIE procedures in Thailand.
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Affiliation(s)
- Somchai Amornyotin
- Somchai Amornyotin, Department of Anesthesiology and Siriraj Gastrointestinal Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Bedirli N, Egritas O, Cosarcan K, Bozkirli F. A comparison of fentanyl with tramadol during propofol-based deep sedation for pediatric upper endoscopy. Paediatr Anaesth 2012; 22:150-5. [PMID: 21958025 DOI: 10.1111/j.1460-9592.2011.03707.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM This study was conducted to compare the efficacy and safety of tramadol with those of fentanyl and to evaluate the impact of age in pediatric patients undergoing upper gastrointestinal endoscopy (UGIE). METHODS Eighty patients with ASA I-II, aged 1-16 years, undergoing UGIE were included in this study. Baseline anesthesia was maintained with 1 mg·kg(-1) propofol, and then, the patients were randomly assigned to receive 2 μg·kg(-1) fentanyl (group F, n = 40) or 2 mg·kg(-1) tramadol (group T, n = 40). Additional propofol, 0.5-1 mg·kg(-1), was administered when needed. Heart rate, mean arterial pressure, oxygen saturation (SpO(2)), and sedation scores were recorded at baseline, induction, and every 5 min. Endoscopy duration, recovery time, and adverse effects were recorded. The data were separated for subgroup analyses based on the age of 0-2, 2-12, and over 12 years. RESULTS Fentanyl significantly decreased the saturation at induction, 5th min and 10th min in patients of 0-2 years; at 5th and 10th min in 2-12 years; and at 5th min in >12 years. In all age subgroups, sedation scores at 10th, 15th, and 20th min, the overall frequency of adverse effects, and the recovery time were significantly lower in group T compared with group F. CONCLUSION Tramadol in pediatric patients undergoing UGIE provided sedation as efficient as fentanyl with a better hemodynamic and respiratory stability and provided a superior safety and tolerance in younger children.
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Affiliation(s)
- Nurdan Bedirli
- Anesthesiology and Reanimation Department, Medical Faculty, Gazi University, Ankara, Turkey.
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Yang CT, Chen HL, Ho MC, Shinn-Forng Peng S. Computed tomography indices and criteria for the prediction of esophageal variceal bleeding in survivors of biliary atresia awaiting liver transplantation. Asian J Surg 2011; 34:168-74. [DOI: 10.1016/j.asjsur.2011.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 06/16/2011] [Accepted: 09/01/2011] [Indexed: 02/07/2023] Open
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Amornyotin S, Chalayonnawin W, Kongphlay S. Deep sedation for endoscopic retrograde cholangiopancreatography: a comparison between clinical assessment and Narcotrend(TM) monitoring. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2011; 4:43-9. [PMID: 22915929 PMCID: PMC3417873 DOI: 10.2147/mder.s17236] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Moderate to deep sedation is generally used for endoscopic retrograde cholangiopancreatography (ERCP). The depth of sedation is usually judged by clinical assessment and electroencephalography-guided monitoring. The aim of this study was to compare the clinical efficacy of clinical assessment and Narcotrend(TM) monitoring during deep-sedated ERCP. METHODS One hundred patients who underwent ERCP in a single year were randomly assigned to either group C or group N. Patients in group C (52) were sedated using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale. Patients in group N (48) were sedated using the Narcotrend(TM) system. The MOAA/S scale 1 or 2 and the Narcotrend(TM) index 47-56 to 57-64 were maintained during the procedure. The primary outcome variable of the study was the successful completion of the endoscopic procedure. The secondary outcome variables were the total dose of propofol used during the procedure, complications during and immediately after procedure, and recovery time. RESULTS All endoscopies were completed successfully. The mean total dose of propofol in group C was significantly lower than that in group N. However, the mean dose of propofol, expressed as dose/kg or dose/kg/h in both groups, was not significantly different (P = 0.497, 0.136). Recovery time, patient tolerance and satisfaction, and endoscopist satisfaction were comparable between the two groups. All sedation-related adverse events during and immediately after the procedure, such as hypotension, hypertension, tachycardia, bradycardia, transient hypoxia, and upper airway obstruction, in group C (62.2%) were significantly higher than in group N (37.5%) (P = 0.028). CONCLUSION Clinical assessment and Narcotrend(TM)-guided sedation using propofol for deep sedation demonstrated comparable propofol dose and recovery time. Both monitoring systems were equally safe and effective. However, the Narcotrend(TM)-guided sedation showed lower hemodynamic changes and fewer complications compared with the clinical assessment-guided sedation.
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Affiliation(s)
- Somchai Amornyotin
- Department of Anesthesiology and Siriraj GI Endoscopy Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Current World Literature. Curr Opin Anaesthesiol 2010; 23:532-8. [DOI: 10.1097/aco.0b013e32833c5ccf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Amornyotin S, Aanpreung P. Clinical effectiveness of an anesthesiologist-administered intravenous sedation outside of the main operating room for pediatric upper gastrointestinal endoscopy in Thailand. Int J Pediatr 2010; 2010:748564. [PMID: 20811603 PMCID: PMC2929513 DOI: 10.1155/2010/748564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 06/23/2010] [Accepted: 06/23/2010] [Indexed: 02/07/2023] Open
Abstract
Objectives. To review our sedation practice and to evaluate the clinical effectiveness of an anesthesiologist-administered intravenous sedation outside of the main operating room for pediatric upper gastrointestinal endoscopy (UGIE) in Thailand. Subjects and Methods. We undertook a retrospective review of the sedation service records of pediatric patients who underwent UGIE. All endoscopies were performed by a pediatric gastroenterologist. All sedation was administered by staff anesthesiologist or anesthetic personnel. Results. A total of 168 patients (94 boys and 74 girls), with age from 4 months to 12 years, underwent 176 UGIE procedures. Of these, 142 UGIE procedures were performed with intravenous sedation (IVS). The mean sedation time was 23.2 +/- 10.0 minutes. Propofol was the most common sedative drugs used. Mean dose of propofol, midazolam and fentanyl was 10.0 +/- 7.5 mg/kg/hr, 0.2 +/- 0.2 mg/kg/hr, and 2.5 +/- 1.2 mcg/kg/hr, respectively. Complications relatively occurred frequently. All sedations were successful. However, two patients became more deeply than intended and required unplanned endotracheal intubation. Conclusion. The study shows the clinical effectiveness of an anesthesiologist-administered IVS outside of the main operating room for pediatric UGIE in Thailand. All complications are relatively high. We recommend the use of more sensitive equipments such as end tidal CO(2) and carefully select more appropriate patients.
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Affiliation(s)
- Somchai Amornyotin
- 1Department of Anesthesiology and Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
- *Somchai Amornyotin:
| | - Prapun Aanpreung
- 2Department of Pediatric and Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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