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Complications during esophageal endoscopy with or without baloon dilation under general anesthesia in pediatric
Pinar Kendigelen1, Ayse C Tutuncu2, Senol Emre3
1Department of Anesthesiology and Intensive Care, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Insights
Pediatric esophagoscopy, particularly with balloon dilation, can cause significant increases in peak inspiratory pressure (PIP), especially in younger children. Careful monitoring for cardio-respiratory complications during and after these procedures is essential.
Area of Science:
- Pediatric Gastroenterology
- Anesthesiology
- Cardiopulmonary Physiology
Background:
- Esophagoscopy in children, especially with dilation techniques, carries risks of cardio-respiratory complications.
- Understanding these risks is crucial for patient safety during pediatric endoscopic procedures.
Purpose of the Study:
- To identify cardio-respiratory alterations during esophagoscopy with or without balloon dilation in children under anesthesia.
- To investigate the incidence of postoperative complications associated with these procedures.
Main Methods:
- A prospective, observational study involving 102 procedures in 60 pediatric patients (0-16 years).
- Patients were divided into an endoscopy-dilation group (Group ED) and an endoscopy-only group (Group E).
- Hemodynamic and ventilatory parameters were recorded during the procedure and for two hours postoperatively.
Main Results:
- Peak inspiratory pressure (PIP) significantly increased after endoscopy in both groups.
- The dilation group showed a significant increase in PIP during the procedure.
- PIP increase was negatively correlated with age, with significant increases observed in children under two years old.
- Heart rate (HR) also significantly increased in the dilation group during the procedure.
Conclusions:
- Esophagoscopy, with or without balloon dilation, leads to increased PIP in pediatric patients, particularly those undergoing dilation.
- Younger children (<2 years) experience a more pronounced PIP increase.
- Close observation and management of severe respiratory and cardiovascular complications are critical during balloon dilation under general anesthesia.
Background:
Complications can occur during esophagoscopy as a result of applied procedure in children, especially during dilation techic. Our aim was to identify cardio-respiratory alterations during esophagoscopy with or without baloon dilation under anesthesia in children, and to investigate the postoperative complications.
Methods:
Prospective, observational study of endoscopic procedures in patients 0-16 years. The patients were divided into two groups: the endoscopy-dilation group (Group ED: endoscopy and balloon dilation due to esophageal stricture) and endoscopy without dilation (Group E: endoscopy for diagnostic reasons, control esophagoscopy or sclerotherapy). Hemodynamic and ventilatory parameters alterations and complications during endoscopy, dilation and two-hours follow-up time in the postoperative recovery room were recorded.
Results:
102 procedures in 60 patients were included. Peak inspiratory pressure (PIP) values significantly increased after endoscopy in both groups (p<0.001). There was a significant increase in mean PIP values in the dilation group during the procedure (p<0,001). The difference in PIP values before and after the endoscopy was negatively correlated with age in both groups. When the groups were subdivided taking two years of age as a cut-off point in comparing PIP difference before-after endoscopy, PIP increase was statistically significant in both groups under two-years old. In the dilation group, statistically significant increase of HR was detected during the procedure (p<0,001).
Conclusion:
During endoscopy PIP increased in patients with or without baloon dilation especially in the dilation group. PIP increase was higher in younger children. Severe respiratory and cardiovascular complications during balloon dilation under general anesthesia should be carefully observed and managed.
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