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Published on: January 13, 2017
Comparison of different anesthesia techniques during esophagogastroduedenoscopy in children: a randomized trial
Mario Patino1, Susan Glynn1, Mark Soberano1
1Department of Anesthesiology, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA.
Insights
For pediatric esophagogastroduodenoscopy (EGD), intubated anesthesia with sevoflurane or propofol is safer than a native airway technique. The native airway approach increased respiratory complications without improving operating room efficiency.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Airway Management
Background:
- Pediatric esophagogastroduodenoscopy (EGD) typically requires general anesthesia.
- Optimizing anesthetic techniques is crucial for minimizing airway complications and maximizing operating room (OR) efficiency.
- Current consensus lacks guidance on the optimal anesthetic approach for pediatric EGD.
Purpose of the Study:
- To compare the incidence of respiratory complications and institutional efficiency across three distinct anesthetic techniques for pediatric EGD.
- To determine the safety and efficacy of intubated versus non-intubated anesthesia in this population.
Main Methods:
- A prospective randomized study involving 179 children (1-12 years) undergoing EGD.
- Three anesthetic groups were compared: intubated sevoflurane (IS), intubated propofol (IP), and native airway propofol (NA).
- Respiratory complications and institutional efficiency metrics (e.g., OR time, recovery) were meticulously recorded.
Main Results:
- The native airway group (NA) exhibited a significantly higher incidence of respiratory complications (0.459) compared to the intubated groups (IS: 0.033, IP: 0.086).
- Common complications included desaturation, inadequate anesthesia, and apnea.
- No significant differences in institutional efficiency were observed among the three anesthetic techniques.
Conclusions:
- Anesthesia techniques involving intubation (sevoflurane or propofol) are associated with fewer respiratory complications during pediatric EGD.
- Utilizing a native airway with propofol maintenance does not confer benefits regarding respiratory safety or operational efficiency.
- Intubated anesthesia strategies appear preferable for pediatric EGD.
Background:
Esophagogastroduedenoscopy (EGD) in children is usually performed under general anesthesia. Anesthetic goals include minimization of airway complications while maximizing operating room (OR) efficiency. Currently, there is no consensus on which anesthetic technique best meets these goals. We performed a prospective randomized study comparing three different anesthetic techniques.
Aims:
To evaluate the incidence of respiratory complications (primary aim) and institutional efficiency (secondary aim) among three different anesthetic techniques in children undergoing EGD.
Methods:
Subjects received a standardized inhalation induction of anesthesia followed by randomization to one of the three groups: Group intubated, sevoflurane (IS), Group intubated, propofol (IP), and Group native airway, nonintubated, propofol (NA). Respiratory complications included minor desaturation (SpO2 between 94% and 85%), severe desaturation (SpO2 < 85%), apnea, airway obstruction/laryngospasm, aspiration, and/or inadequate anesthesia during the endoscopy. Evaluation of institutional efficiency was determined by examining the time spent during the different phases of care (anesthesia preparation, procedure, OR stay, recovery, and total perioperative care).
Results:
One hundred and seventy-nine children aged 1-12 years (median 7 years; 4.0, 10.0) were enrolled (Group IS N = 60, Group IP N = 59, Group NA N = 61). The incidence of respiratory complications was higher in the Group NA (0.459) vs Group IS (0.033) or Group IP (0.086) (P < 0.0001). The most commonly observed complications were desaturation, inadequate anesthesia, and apnea. There were no differences in institutional efficiency among the three groups.
Conclusion:
Respiratory complications were more common in Group NA. The use of native airway with propofol maintenance during EGD does not offer advantages with respect to respiratory complications or institutional efficiency.
