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Oxygen saturation during esophagogastroduodenoscopy in children: general anesthesia versus intravenous sedation
T Lamireau1, M Dubreuil, M Daconceicao
1Division of Pediatric Gastroenterology, Children's Hospital, Bordeaux, France.
Insights
Pediatric upper digestive endoscopy under sedation frequently causes hypoxia. General anesthesia is a safer technique, preventing hypoxia and improving procedural conditions for children undergoing endoscopy.
Area of Science:
- Pediatric Gastroenterology
- Anesthesiology
- Patient Safety
Background:
- Hypoxia is a potential risk for pediatric patients undergoing upper digestive endoscopy.
- Sedation for endoscopic procedures may lead to oxygen desaturation in children.
Purpose of the Study:
- To compare the incidence of oxygen desaturation during intravenous sedation versus general anesthesia in pediatric upper digestive endoscopy.
- To evaluate the safety and efficacy of different anesthetic techniques for pediatric endoscopy.
Main Methods:
- A comparative study involving 36 pediatric patients (3 months to 6 years) undergoing esophagogastroduodenoscopy.
- Patients were randomized to receive either intravenous sedation (n=18) or general anesthesia (n=18).
- Monitoring included oxygen pulse oximetry, heart rate, and mean arterial pressure, with post-procedure satisfaction scores recorded.
Main Results:
- Significantly lower minimum oxygen saturation levels were observed in the sedation group (89% ± 5) compared to the general anesthesia group (97% ± 1).
- Hypoxia (oxygen saturation < 95%) occurred in 89% of the sedation group versus 5.5% in the general anesthesia group.
- Profound desaturation (< 90%) occurred in 50% of sedated patients, compared to 0% under general anesthesia, with lower procedural satisfaction in the sedation group.
Conclusions:
- Hypoxia is a frequent complication of upper digestive endoscopy in children managed with sedation.
- General anesthesia provides a safer alternative to sedation, effectively preventing hypoxia.
- General anesthesia facilitates better procedural conditions for gastroenterologists performing pediatric endoscopy.
Background:
Hypoxia may occur in children undergoing upper digestive endoscopy under sedation. The purpose of this study was to compare the occurrence of desaturation during intravenous sedation with that which occurs during general anesthesia.
Methods:
Thirty-six patients between 3 months and 6 years old underwent a diagnostic esophagogastroduodenoscopy under sedation (n = 18) or general anesthesia (n = 18). Oxygen pulse oximetry, heart rate, and mean arterial pressure were monitored throughout the procedure. At the end of the procedure, the operator gave the value of the endoscopy satisfaction score on a scale of I (very good conditions) to IV (impossible procedure).
Results:
The minimum oxygen pulse oximetry value was significantly lower in the sedation group compared with that in the general anesthesia group (89 +/- 5 vs. 97 +/- 1; p < 0.001). In the general anesthesia group, the oxygen pulse oximetry level declined to less than 95% in only one child; but in the sedation group, it declined to less than 95% in 16 patients (5.5% vs. 89%). Nine patients had a profound desaturation in sedation group (oxygen pulse oximetry < 90%); no patients in the general anesthesia group had desaturation (50% vs. 0%). In the general anesthesia group, heart rate and mean arterial pressure remained stable during the whole procedure, whereas in the sedation group, heart rate and mean arterial pressure increased significantly during the procedure. The endoscopy satisfaction score was I in all 18 patients in the general anesthesia group, whereas in the sedation group, it was I in only 2 patients, II in 8 patients, and III in 10 patients.
Conclusions:
These results confirm that hypoxia during upper digestive endoscopy in patients under sedation is a frequent occurrence in children. When compared with sedation, general anesthesia is a safer technique that prevents hypoxia and allows the gastroenterologist to perform the endoscopy under better conditions.