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Pulse oximetry and upper intestinal endoscopy in infants and children
1Children's Hospital of Orange County, California.
Insights
Pediatric upper endoscopy is safe with parenteral sedation and pulse oximetry monitoring. Oxygen desaturation can occur but is manageable, potentially avoiding general anesthesia for children under three.
Area of Science:
- Pediatric Gastroenterology
- Anesthesiology
- Medical Device Technology
Background:
- Upper intestinal endoscopy in infants and children traditionally recommended general anesthesia.
- Parenteral sedation offers an alternative, but safety concerns regarding oxygenation exist.
Purpose of the Study:
- To evaluate the safety and efficacy of upper intestinal endoscopy in young children using parenteral sedation.
- To assess the role of pulse oximetry in monitoring oxygen saturation during these procedures.
Main Methods:
- Fifty-seven pediatric patients (6 weeks to 36 months) underwent 60 flexible upper intestinal endoscopies.
- All patients received parenteral sedation only and were monitored using pulse oximetry and EKG.
- Oxygen saturation levels were closely observed, especially during sedation and endoscope insertion.
Main Results:
- All procedures were completed without significant complications.
- Transient mild oxygen desaturation occurred in most patients upon endoscope introduction.
- Seven patients experienced significant oxygen desaturation (<90%) post-sedation, which resolved with nasal cannula oxygen.
- Pulse oximetry proved effective in identifying desaturation events.
Conclusions:
- Parenteral sedation combined with pulse oximetry monitoring allows for safe upper intestinal endoscopy in young children.
- Routine general anesthesia may not be necessary for this age group with current monitoring and equipment.
- Pulse oximetry is a valuable tool for early detection of hypoxemia and guiding oxygen therapy.
Abstract:
Infants and children undergoing upper intestinal endoscopy were monitored by both pulse oximetry and chest EKG. Fifty-seven patients between the ages of 6 weeks and 36 months underwent 60 flexible upper intestinal endoscopies. All patients received parenteral sedation only. All procedures were successfully performed without significant complications. In 53 of the patients there was only transient mild oxygen desaturation with introduction of the endoscope into the pharynx and upper esophagus. In contrast, in seven patients, oxygen desaturation to less than 90% was noted following sedation but prior to insertion of the endoscope without overt clinical evidence of complications. Oxygen administered by nasal cannula resulted in a return of the oxygen saturation to at least the preprocedural level and allowed for safe completion of the studies. With improved monitoring, the use of smaller, more flexible endoscopes, and more experience, routine general anesthesia in children less than 3 years of age, as recommended in the past, may not be mandatory. Pulse oximetry may be particularly useful as an early indicator of poor oxygenation and may provide an objective means to assess the need for supplemental oxygen and to determine the degree of postprocedural observation.