Data on safety of intravenous sedation in pediatric gastrointestinal (GI) endoscopy are sparse.
Dr Petar Mamula and colleagues from Pennsylvania evaluated safety of intravenous sedation for GI endoscopy.
The team performed a single-center prospective series of outpatient GI endoscopies from 2003 to 2004 at The Children's Hospital of Philadelphia.
The recorded information included demographic, medication, and adverse event data.
The investigative team studied a total of 1226 patients, and performed a total of 2635 endoscopies.
|Vomiting occurred in 5% of patients|
The team's main outcome measurements included adverse events relating to intravenous sedation.
Of the total endoscopies undertaken, 1717 were outpatient procedures with the patient under intravenous sedation.
Sedation data were available on 1578 procedures.
Of these, 758 were esophagogastroduodenoscopies, 116 were colonoscopies alone.
The team reported that 352 procedures were combined esophagogastroduodenoscopies and colonoscopies.
The median dose of fentanyl was 2.8 μg/kg, and for midazolam it was 0.1 mg/kg.
The investigators found that the mean recovery time was 118 minutes.
The team observed that about 1% of patients failed intravenous sedation.
Serious adverse events, specifically apnea, were noted in less than 1% of patients.
Mild or moderate adverse events included desaturation below 92% for less than 20 seconds in 9% of patients.
The investigators noted that vomiting occurred in 5% of patients, and agitation in 1%.
The team observed desaturation below 92% for greater than 20 seconds, and a rash in about 1% of patients.
No cardiopulmonary resuscitation or sedation reversal was necessary.
However, the team found that patients younger than 6 years were more likely to develop respiratory adverse events.
The investigative team noted that no patients required hospitalization.
Dr Mamula's team concludes, “Intravenous sedation with midazolam and fentanyl is safe for pediatric GI endoscopy.”
“Serious adverse events are rare and no patient required hospitalization.”