Anesthesia for pediatric gastrointestinal endoscopy in a tertiary care teaching hospital

Authors : Amornyotin S, Prakanrattana U, Chalayonnavin W, Kongphlay S, Chantakard S

DOI :

Volume : 34

Issue : 4

Year : 2008

Page No : 265-272

Background : Pediatric gastrointestinal endoscopy (GIE) is a procedure for diagnosis and treatment of GI abnormalities. It can be performed without sedation, with intravenous sedation or with general anesthesia. The methods by which a child is anesthetized remain controversial. Objective : To evaluate the clinical efficacy of anesthesia/sedation for pediatric GIE in a tertiary-care teaching hospital in Thailand. Methods : Retrospectively analyzed the children on whom GI endoscopy had been performed during the period of January, 2006 to June, 2008 in Siriraj Hospital. The patients’ characteristics, pre-anesthetic problems, anesthetic techniques, agents, time and complications, as well as endoscopic procedures were assessed and summarized by using descriptive statistics. Results : There were 258 cases and 274 endoscopic procedures ; i.e. esophagogastroduodenoscopy (EGD) (87.2%), colonoscopy (5.4%), EGD and colonoscopy (6.2%) and others (1.2%). Mean age was 8.2 (SD, 4.6) years and ranged from 4 months to 17 years. The majority of them were classified in ASA class III (37.2%). Patients most often had esophageal varice (22.5%), abdominal pain (15.5%), upper gastrointestinal hemorrhage (12.8%), anemia (10.5%), corrosive esophagitis (6.2%) and others. Most common pre-anesthetic problems were hematologic diseases (63.4%), liver diseases (45.9%) and electrolyte imbalance (20.9%). Intravenous sedation (65.5%) and general anesthesia with endotracheal tube (15.9%) were the main anesthetic techniques. The main anesthetic agents used were propofol, fentanyl and midazolam. Mean duration of endoscopy was 30.2 minutes and ranged in time from 10 to 110 minutes. Overall complication rate was 17.8%. Hypotension (12.8%) was the most frequent anesthetic complication. Conclusion : Anesthesia / sedation performed by anesthetic personnel for pediatric GIE is relatively safe and effective. Serious adverse events are rare.