Sedation for Diagnostic Upper Gastrointestinal Endoscopy: a Survey of the Francophone Pediatric Hepatology, Gastroenterology, and Nutrition Group

Background and Study Aims: A survey of sedation usage in children undergoing diagnostic upper gastrointestinal endoscopy was undertaken among the members of the Francophone Pediatric Hepatology, Gastroenterology, and Nutrition Group.
Materials and Methods: A questionnaire regarding the mode of sedation used for noninterventional upper gastrointestinal endoscopy, relative to the patient’s age and clinical condition, was sent to all members of the Group. The sample included 51 pediatric endoscopy centers (33 university hospitals, eight general hospitals, and 10 private practices).
Results: The response rate was 84 % (43 of 51) overall, and 100 % for university hospitals. Forty percent of the pediatric endoscopy centers routinely offered children and/or parents a choice between general anesthesia and conscious sedation. Only 14 % of the pediatric endoscopists surveyed routinely conducted upper gastrointestinal endoscopy under general anesthesia, irrespective of the patient’s age or the indication for endoscopy. Patients under the age of 6 months underwent endoscopy as follows: 35 % under conscious sedation, 22 % under general anesthesia, and 43 % with no sedation. After the age of 6 months, endoscopy was conducted as follows: 45 % under conscious sedation, 47 % under general anesthesia, and 8 % with no sedation. Midazolam was the most common drug used for conscious sedation. In patients aged 3 - 5, inhaled nitrous oxide was used instead of midazolam for conscious sedation in 12 % of pediatric endoscopies, and local anesthesia with lidocaine (Xylocaine) in 24 %. In those over the age of 5, the proportions of centers using inhaled nitrous oxide and lidocaine increased to 19 % and 42 %, respectively.
Conclusions: These results clearly show that the mode of sedation used in noninterventional upper gastrointestinal endoscopy in the pediatric age group is highly variable.

References

• 1 Chuang E, Zimmerman A, Neiswender K M, Liacouras C A. Sedation in pediatric endoscopy.  Gastrointest Endosc Clin North Am. 2001;  11 569-584
• 2 American Academy of Pediatrics Committee on Drugs, Section on Anesthesiology. Guidelines for the elective use of conscious sedation, deep sedation and general anaesthesia.  Pediatrics. 1985;  76 317-321
• 3 Lamireau T, Dubreuil M, Daconccicao M. Oxygen saturation during oesophago-gastroduodenoscopy in children: general anesthesia versus intravenous sedation.  J Pediatr Gastroenterol Nutr. 1998;  27 172-175
• 4 Squires R H, Morriss F, Schleuterman S. et al . Efficacy, safety, cost of intravenous sedation versus general anesthesia in children undergoing endoscopic procedures.  Gastrointest Endosc. 1995;  41 99-104
• 5 Bishop P R, Nowicki M J, May W L. et al . Unsedated upper endoscopy in children.  Gastrointest Endosc. 2002;  55 624-630
• 6 Massanari M, Novitsky J, Reinstein L J. Paradoxical reactions in children associated with midazolam use during endoscopy.  Clin Pediatr. 1997;  36 681-684
• 7 Annequin D, Carbajal R, Chauvin P. et al . Fixed 50 % nitrous oxide mixture for painful procedures: a French survey.  Pediatrics. 2000;  105 E47
• 8 Michaud L, Gottrand F, Ganga-Zandzou P S. et al . Nitrous oxide sedation in pediatric patients undergoing gastrointestinal endoscopy.  J Pediatr Gastroenterol Nutr. 1999;  28 310-314
• 9 Hassall E. Should pediatric gastroenterologists be i.v. drug users?.  J Pediatr Gastroenterol Nutr. 1993;  16 370-372
• 10 Hedenbro J L, Lindblom A. Patient attitudes to sedation for diagnostic upper endoscopy.  Scand J Gastroenterol. 1991;  26 1115-1120
• 11 McCloy R F, Pearson R C. Which agents and how to deliver it? A review of benzodiazepine sedation and its reversal in endoscopy.  Scand J Gastroenterol Suppl. 1990;  19 7-11
• 12 Lee D WH, Chan K W, Poon C M. et al . Relaxation music decreases the dose of patient-controlled sedation during colonoscopy: a prospective randomized controlled trial.  Gastrointest Endosc. 2002;  55 33-36