Propofol as Standard of Care for Pediatric Sedation for Short Procedures, Such As Upper Endoscopy

Andrade, Stefanny; Battistuz, Elena; Leo, Grazia Di; Barbi, Egidio

doi:10.1097/mpg.0000000000002561

Cited by 2 publications

(2 citation statements)

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“…Although many sedatives have been shown to be safe and effective for endoscopic sedation, all have the potential to significantly depress the central nervous system, airway protective reflexes, and ventilation ( 1 , 12 , 26 ). Those with narrow therapeutic windows such as propofol may be even more likely to be associated respiratory events ( 7 , 15 ). Kaddu et al reported that 20% of pediatric patients receiving anesthesiologist administered propofol for upper endoscopy experienced transient apnea ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

“…Historically, pediatric endoscopic sedation has been administered by endoscopists or anesthesiologists, and is generally considered necessary for children to undergo procedures (4). 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%

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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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