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Oxygen desaturation and cardiac arrhythmias in children during esophagogastroduodenoscopy using conscious sedation
M A Gilger1, S D Jeiven, J O Barrish
1Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Insights
Conscious sedation for pediatric esophagogastroduodenoscopy frequently causes oxygen desaturation and cardiac arrhythmias, but these are typically minor and resolve spontaneously. Continuous monitoring is recommended to ensure patient safety during these procedures.
Area of Science:
- Pediatric Gastroenterology
- Cardiology
- Anesthesiology
Background:
- Esophagogastroduodenoscopy (EGD) in children often requires conscious sedation.
- Potential risks include oxygen desaturation and cardiac arrhythmias.
- Monitoring protocols for these risks are crucial.
Purpose of the Study:
- To investigate the incidence of oxygen desaturation and cardiac arrhythmias in children undergoing EGD with conscious sedation.
- To assess the safety and clinical outcomes associated with these events.
- To evaluate predictors of adverse events.
Main Methods:
- Prospective study of 34 pediatric patients (2 months to 18 years).
- Patients categorized as normal or high-risk based on pre-existing conditions.
- Intravenous sedation administered; continuous monitoring of pulse oximetry, respiratory rate, and ECG.
Main Results:
- Oxygen desaturation (<90%) occurred in 68% of normal and 58% of high-risk patients.
- Arrhythmias were observed in 82% of normal and 75% of high-risk patients, often linked to desaturation.
- Sinus tachycardia was the most common arrhythmia; no adverse outcomes were reported.
- No specific patient subgroups predicted desaturation or arrhythmias.
Conclusions:
- Conscious sedation for pediatric EGD is generally safe, with transient desaturation and arrhythmias being common but usually resolving spontaneously.
- Despite the low incidence of adverse outcomes, inherent risks exist.
- Routine continuous cardiac rhythm and pulse oximetry monitoring is strongly advocated for all children during sedated EGD.
Abstract:
To determine whether oxygen desaturation and cardiac arrhythmias occur in children during esophagogastroduodenoscopy with the use of conscious sedation, we prospectively studied 34 consecutive patients between the ages of 2 months and 18 years. Patients with pulmonary, cardiac, and neurologic disorders were defined as high risk and those without were defined as normal. All patients received intravenous sedation with meperidine, diazepam, or midazolam, used alone or in combination. Pulse oximetry, respiratory rate, and lead II electrocardiogram were recorded throughout all episodes of desaturation and tachycardia. Oxygen desaturation to less than 90% occurred in 68% of normal patients and in 58% of high-risk patients during esophagogastroduodenoscopy. Seventy-five percent of the high-risk patients and 82% of the normal patients had an arrhythmia during esophagogastroduodenoscopy usually associated with oxygen desaturation. Sinus tachycardia was the most common arrhythmia, although other arrhythmias were identified. Despite the frequency of oxygen desaturation and cardiac arrhythmias, no adverse outcome was observed in any patient. Most episodes of oxygen desaturation and cardiac arrhythmia resolved spontaneously. Subdivision of patients into high-risk groups by age, sex, weight, or diameter of endoscope used did not allow prediction of oxygen desaturation or cardiac arrhythmia. Our data suggest that conscious sedation in children undergoing esophagogastroduodenoscopy is safe and free of significant adverse clinical problems. However, conscious sedation during esophagogastroduodenoscopy continues to have certain inherent risks. Therefore we strongly advocate the routine use of continuous cardiac rhythm and pulse oximetry monitoring of all children during esophagogastroduodenoscopy performed with the use of conscious sedation.