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Adverse events related to gastrointestinal endoscopic procedures in pediatric patients under anesthesia care and a
F Ariza1, D Montilla-Coral1, O Franco2
1Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia.
Insights
Adverse events (AEs) during pediatric gastrointestinal endoscopic procedures (GEP) are infrequent when general anesthesia (GA) is preferred. Key risk factors for AEs include age under 1 year, recent upper respiratory infections, and low weight for age.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Patient Safety
Background:
- Gastrointestinal endoscopic procedures (GEP) in children often utilize deep sedation.
- Previous studies focused on perioperative factors for adverse events (AEs) in GEP.
- General anesthesia (GA) is sometimes preferred over deep sedation for pediatric GEP.
Purpose of the Study:
- To analyze perioperative factors associated with AEs in children undergoing GEP.
- To identify risk factors and protective elements for AEs in pediatric GEP.
- To compare outcomes between deep sedation and GA in pediatric GEP.
Main Methods:
- Retrospective review of an anesthesia institutional database.
- Inclusion of children under 12 years undergoing GEP over a 5-year period.
- Logistic regression analysis to identify significant associations with AEs.
Main Results:
- General anesthesia (GA) was preferred (77.8%) over deep sedation for 2178 GEP.
- Most frequent AEs included hypoxemia (1.82%), bronchospasm (1.14%), and laryngospasm (0.91%).
- Independent risk factors for AEs were age <1 year, recent URTI, and low weight for age (LWA); facial mask ventilation was protective.
Conclusions:
- AEs are infrequent and severe AEs are rare when GA is preferred for pediatric GEP.
- Ventilatory AEs are most common and depend on patient factors rather than anesthetic drugs.
- Age <1 year, recent URTI, and LWA are independent risk factors for AEs in pediatric GEP.
Background:
Multiple studies have analyzed perioperative factors related to adverse events (AEs) in children who require gastrointestinal endoscopic procedures (GEP) in settings where deep sedation is the preferred anesthetic technique over general anesthesia (GA) but not for the opposite case.
Methods:
We reviewed our anesthesia institutional database, seeking children less than 12 years who underwent GEP over a 5-year period. A logistic regression was used to determine significant associations between preoperative conditions, characteristics of the procedure, airway management, anesthetic approaches and the presence of serious and non-serious AEs.
Results:
GA was preferred over deep sedation [77.8% vs. 22.2% in 2178 GEP under anesthesia care (n=1742)]. We found 96 AEs reported in 77 patients, including hypoxemia (1.82%), bronchospasm (1.14%) and laryngospasm (0.91%) as the most frequent. There were 2 cases of severe bradycardia related to laryngospasm/hypoxemia and a case of aspiration resulting in unplanned hospitalization, but there were no cases of intra- or postoperative deaths. Final predictive model for perioperative AEs included age <1 year, upper respiratory tract infections (URTI) <1 week prior to the procedure and low weight for the age (LWA) as independent risk factors and ventilation by facial mask as a protector against these events (p<0.05).
Conclusions:
AEs are infrequent and severe ones are remote in a setting where AG is preferred over deep sedation. Ventilatory AEs are the most frequent and depend on biometrical and comorbid conditions more than anesthetic drugs chosen. Age <1 year, history of URTI in the week prior to the procedure and LWA work as independent risk factors for AEs in these patients.
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