Endotracheal Intubation Versus Laryngeal Mask Airway for Esophagogastroduodenoscopy in Children

Acquaviva, Michael A.; Horn, Nicole; Gupta, Sandeep K.

doi:10.1097/mpg.0000000000000348

Cited by 9 publications

(6 citation statements)

References 9 publications

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“…In our study, use of an artificial airway (ETT or LMA) did not raise the risk of developing the most common AEs including throat pain, chest pain, and dysphagia. Our findings are supported by other reports in literature that reviewed the use and safety of ETT and LMA in pediatric endoscopy (10,11). A comparison of ETT and LMA found no difference in recovery times or time to discharge following endoscopy in children, suggesting that immediate post‐operative complication rates are low regardless of type of artificial airway used (10).…”

Section: Discussionsupporting

confidence: 92%

Pre‐endoscopy Symptoms and Age, But Not Esophageal Biopsy Number Are Associated With Post‐endoscopy Adverse Events

Wenzel

Kagalwalla

Wechsler

2022

J. pediatr. gastroenterol. nutr.

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Esophagogastroduodenoscopy (EGD) is a frequently utilized investigative tool in the management of gastrointestinal conditions in children. Biopsies obtained during EGD may pose risk for post-operative adverse events (AEs), and further understanding of risk is imperative to provide informed consent to families and safe patient care. In particular, the impact of biopsy number and location on the development of AEs has not been studied in pediatric patients. We prospectively assessed for AEs by telephone survey 3–7 days after 209 EGDs performed on patients ages 1–21 years over a 1-year period. Demographic, endoscopic, and histologic data were collected. The most common symptoms reported were throat pain (61%), chest pain (26%), and dysphagia (26%). Binary regression models identified age and pre-operative symptoms as factors that influenced the likelihood of post-operative morbidity. Multiple biopsies from 3 different locations of the esophagus did not impact the risk of post-operative AEs.

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Section: Discussionsupporting

confidence: 92%

Pre‐endoscopy Symptoms and Age, But Not Esophageal Biopsy Number Are Associated With Post‐endoscopy Adverse Events

Wenzel

Kagalwalla

Wechsler

2022

J. pediatr. gastroenterol. nutr.

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“…Nevertheless, the use of CO 2 as an insufflation gas during endoscopy is an additional variable that must be considered during EtCO 2 monitoring. The LMA has been shown to be as effective for ventilation and gas exchange as the ETT for healthy children undergoing EGD ( 18 ). Therefore, we theorized that protecting the airway with either an LMA or ETT should minimize the possibility of contamination of sampled end-tidal gas by eructated CO 2 as we had proposed to be the cause of elevated EtCO 2 with CO 2 endoscopic insufflation ( 7 , 8 ).…”

Section: Discussionmentioning

confidence: 99%

Elevations in End-Tidal CO2 With CO2 Use During Pediatric Endoscopy With Airway Protection: Is This Physiologically Significant?

Dike¹,

Pacheco²,

Lyden³

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Background: Inflation of the gastrointestinal lumen is vital for proper visualization during endoscopy. Air, insufflated via the endoscope, is gradually being replaced with carbon dioxide (CO 2 ) in many centers, with the intention of minimizing post-procedural discomfort due to retained gas. Recent studies suggest that the use of CO 2 during pediatric esophagogastroduodenoscopy (EGD) with an unprotected airway is associated with transient elevations in exhaled CO 2 (end-tidal CO 2 , EtCO 2 ), raising safety concerns. One possible explanation for these events is eructation of insufflation gas from the stomach. Objectives: To distinguish eructated versus absorbed CO 2 by sampling EtCO 2 from a protected airway with either laryngeal mask airway (LMA) or endotracheal tube (ETT), and to observe for changes in minute ventilation (MV) to exclude hypoventilation events. Methods: Double-blinded, randomized clinical trial of CO 2 versus air insufflation for EGD with airway protection by either LMA or ETT. Tidal volume, respiratory rate, MV, and EtCO 2 were automatically recorded every minute. Cohort demographics were described with descriptive characteristics. Variables including the percent of children with peak, transient EtCO 2 ≥ 60 mmHg were compared between groups. Results: One hundred ninety-five patients were enrolled for 200 procedures. Transient elevations in EtCO 2 of ≥60 mmHg were more common in the CO 2 group, compared to the air group (16% vs 5%, P = 0.02), but were mostly observed with LMA and less with ETT. Post-procedure pain was not different between groups, but flatulence was reported more with air insufflation ( P = 0.004). Conclusion: Transient elevations in EtCO 2 occur more often with CO 2 than with air insufflation during pediatric EGD despite protecting the airway with an LMA or, to a lesser degree, with ETT. These elevations were not associated with changes in MV. Although no adverse clinical effects from CO 2 absorption were observed, these findings suggest that caution should be exercised when considering the use of CO 2 insufflation, especially since the observed benefits of using this gas were minimal.

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“…Another important concern regarding use of anesthesiologists during pediatric endoscopy is the potential for inefficient use of healthcare resources ( 2 , 8 , 9 , 23 ). For example, unnecessary use of endotracheal intubation for routine diagnostic endoscopy in children has been shown to increase endoscopy room times and costs ( 11 ). While many endoscopists acknowledge increased patient comfort when anesthesiologists provide sedation, it has also been true that variability in anesthesiologist practices can lead to a mismatch between sedation provided and the procedure performed ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

“…The trend toward anesthesiologist-administration has evolved from increasing interest in ensuring patient safety and comfort, (5,6) as well as the ability of propofol to target a spectrum of sedation levels with rapid induction and recovery times (7). However, it is not clear that these and other anticipated benefits of anesthesiologist-administration for pediatric endoscopy have been fully realized, perhaps due to wide variations in care that have yet to be systematically documented or examined (1,(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Variation in Pediatric Anesthesiologist Sedation Practices for Pediatric Gastrointestinal Endoscopy

et al. 2021

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Background: Despite a worldwide shift toward anesthesiologist-administered sedation for gastrointestinal endoscopy in children, ideal sedation regimens remain unclear and best practices undefined.Aim: The aim of our study was to document variation in anesthesiologist-administered sedation for pediatric endoscopy. Outcomes of interest included coefficients of variation, procedural efficiency, as well as adverse events.Methods: IRB approval was obtained to review electronic health records of children undergoing routine endoscopy at our medical center during a recent calendar year. Descriptive and multivariate analyses were used to examine predictors of sedation practices.Results: 258 healthy children [2–21 years (median 15, (Q1–Q3 = 10–17)] underwent either upper and/or lower endoscopies with sedation administered by anesthesiologists (n = 21), using different sedation regimens (29) that ranged from a single drug administered to 6 sedatives in combination. Most patients did not undergo endotracheal tube intubation for the procedure (208, 81%), and received propofol (255, 89%) either alone or in combination with other sedatives. A total of 10 (3.8%) adverse events (9 sedation related) were documented to occur. The coefficient of variation (CV) for sedation times was high at 64.2%, with regression analysis suggesting 8% was unexplained by procedure time. Multivariable model suggested that longer procedure time (p < 0.0001), younger age (p < 0.0001), and use of endotracheal tube intubation (p = 0.02) were associated with longer sedation time.Discussion: We found great variation in anesthesiologist administered regimens for pediatric endoscopy at our institution that may be unwarranted, presenting may opportunities for minimizing patient risk, as well as for optimizing procedural efficiency.

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Endotracheal Intubation Versus Laryngeal Mask Airway for Esophagogastroduodenoscopy in Children

Abstract: The LMA appears to be an acceptable and safe alternative for otherwise healthy children undergoing routine EGD. Benefits appear to be decreased incidence of vomiting and overall decreased time spent in the hospital.

Cited by 9 publications

References 9 publications

Pre‐endoscopy Symptoms and Age, But Not Esophageal Biopsy Number Are Associated With Post‐endoscopy Adverse Events

Pre‐endoscopy Symptoms and Age, But Not Esophageal Biopsy Number Are Associated With Post‐endoscopy Adverse Events

Elevations in End-Tidal CO2 With CO2 Use During Pediatric Endoscopy With Airway Protection: Is This Physiologically Significant?

Variation in Pediatric Anesthesiologist Sedation Practices for Pediatric Gastrointestinal Endoscopy

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