Background and Study Aims: The need to administer procedural sedation to children has increased in recent years,
as has experience in this field among nonanesthesiologists. Using propofol makes it
easier to achieve sufficiently deep sedation. There is a considerable literature on
the administration of propofol by nonanesthesiologists for gastroscopy in adults,
but very few data are available on this issue in children. The aim of the present
study was to assess the safety and efficacy of procedural sedation with propofol for
gastroscopy in a pediatric ward with trained personnel and monitoring facilities.Patients and Methods: A training protocol was developed to educate nurses and residents. Children requiring
gastroscopy were included in the study prospectively and underwent procedural sedation
with propofol administered by nonanesthesiologists.Results: A total of 811 upper gastrointestinal endoscopies were carried out with procedural
sedation. Sedation was achieved in all procedures, and all but three (0.4 %) were
conducted successfully. None of the patients required intubation. Stridor with signs
of upper airway obstruction occurred in 14 of the 811 procedures (1.7 %). Laryngoscopy
was required to manage difficulties in introducing the gastroscope in 16 of the 811
procedures (2.0 %). Major desaturation requiring a short course of ventilation occurred
in six procedures (0.7 %), and transient desaturation that resolved spontaneously
occurred in 97 of the procedures (12 %).Conclusions: Administration of propofol by nonanesthesiologists for gastroscopy examinations in
children was successful in this study, but was associated with a small risk of potentially
severe complications. Although the residents were generally able to administer procedural
sedation alone, constant and immediate availability of anesthesiological support continues
to be mandatory.
References
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