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Arterial blood oxygen desaturation in infants and children during upper gastrointestinal endoscopy
H B Casteel1, S C Fiedorek, E A Kiel
1Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock.
Insights
Pediatric upper gastrointestinal endoscopy can cause unpredictable oxygen desaturation in children. Continuous monitoring with pulse oximetry is recommended for all pediatric patients undergoing this procedure.
Area of Science:
- Pediatric Gastroenterology
- Cardiopulmonary Physiology
Background:
- Upper gastrointestinal endoscopy in adults is associated with oxygen desaturation and ECG changes.
- Limited data exists on the cardiorespiratory effects of endoscopy in pediatric patients.
Purpose of the Study:
- To evaluate the incidence and predictors of arterial oxygen desaturation and electrocardiographic changes during upper gastrointestinal endoscopy in infants and children.
Main Methods:
- Prospective study of 32 children under 12 years undergoing endoscopy.
- Continuous monitoring using pulse oximetry and electrocardiography before, during, and after the procedure.
- Intravenous sedation was administered.
Main Results:
- Oxygen desaturation (≤90%) occurred in 37.5% of patients, primarily during the procedure.
- Sinus tachycardia was the most frequent ECG finding; no significant abnormalities were noted.
- Desaturation was unpredictable and not correlated with age, weight, medication, or procedural tolerance.
Conclusions:
- Pediatric upper gastrointestinal endoscopy carries a risk of unpredictable oxygen desaturation.
- Continuous pulse oximetry monitoring is advisable for all children undergoing this procedure.
- Patients with cardiopulmonary disease may be at higher risk.
Abstract:
Arterial blood oxygen desaturation and abnormal electrocardiographic changes have been reported in adults undergoing upper gastrointestinal endoscopy. We studied 32 infants and children less than 12 years of age using pulse oximetry and continuous electrocardiography before, during, and after upper gastrointestinal endoscopy performed under intravenous sedation. Sinus tachycardia was the most common electrocardiographic change, and no clinically significant electrocardiographic abnormalities were induced by the procedure. Desaturation to less than or equal to 90% was found in 37.5% of the patients and was most commonly noted during the endoscopy procedure and in patients with cardiopulmonary disease. The desaturation was unpredictable because there was no correlation between desaturation and medication, tolerance to the procedure, weight, or age of the child. Some patients who subjectively appeared to tolerate the procedure well had significant desaturation. The use of pulse oximetry should be considered for all children undergoing upper gastrointestinal endoscopy.