Propofol for Pediatric Colonoscopy

Cohen, Shlomi; Glatstein, Miguel; Scolnik, Dennis; Rom, Liat; Yaron, Ayala; Otremski, Sorina; Ben‐Tov, Amir; Reif, Shimon

doi:10.1097/mjt.0b013e31826a94e9

Cited by 15 publications

(4 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Physiological differences between pediatric and adult patients alter the risks of potentially serious complications during sedation. Propofol, a phenol derivative with sedative, hypnotic, and anesthetic properties without analgesic effects, is routinely used for pediatric sedation[ 7 ]. The major disadvantage of propofol is its narrow therapeutic range and the risk of inadvertent anesthesia.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Study to determine guidelines for pediatric colonoscopy

Yoshioka

Takedatsu

Fukunaga

et al. 2017

WJG

View full text Add to dashboard Cite

AIMTo investigated characteristics, diagnosis, bowel-cleansing preparation, sedation, and colonoscope length and diameter in Japanese pediatric patients receiving total colonoscopy.METHODSThe present study evaluated consecutive patients aged ≤ 15 years who had undergone their first colonoscopy in Kurume University between January 2007 and February 2015. Data were retrospectively analyzed. We identified 110 pediatric patients who had undergone colonoscopy that had reached the cecum, allowing the observation of the total colon.RESULTSHematochezia, abdominal pain, and diarrhea were the most common symptoms. For bowel-cleansing preparation, pediatric patients aged ≤ 12 years were treated with magnesium citrate, and patients aged 13-15 years were treated with polyethylene glycol 4000. For sedation, thiamylal with pentazocine, which has an analgesic effect, was used in patients aged ≤ 6 years, and midazolam with pentazocine was used in patients aged ≥ 7 years. Regarding the choice of endoscope, short and thin endoscopes were selected for younger patients, particularly patients aged ≤ 3 years. Positive diagnoses were made in 78 patients (70.9%). Inflammatory bowel disease (n = 49, 44.5%), including ulcerative colitis (n = 37, 33.6%) and Crohn’s disease (n = 12, 10.9%), was the most common diagnosis.CONCLUSIONColonoscopy offers a high diagnostic capability for pediatric patients with gastrointestinal symptoms. The selection of appropriate management the performance of colonoscopy is important in pediatric patients.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Bowel preparation regimens for pediatric colonoscopy have yet to be standardized and vary among medical centers. Propofol is commonly used for sedation during pediatric endoscopy[ 7 ]. The use of midazolam, fentanyl, meperidine, ketamine, and ketofol in pediatric colonoscopy have also been reported[ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Study to determine guidelines for pediatric colonoscopy

Yoshioka

Takedatsu

Fukunaga

et al. 2017

WJG

View full text Add to dashboard Cite

show abstract

“…Reduction involves inserting a French Foley catheter into the rectum and instilling water or air under pressure into the colon . No studies have objectively quantified pain during reduction, but it is believed to be painful based on analogies with colonoscopy, where the bowel is also distended with gas and children usually require sedation . In contrast, reduction of ileocolic intussusception is usually performed on awake children without sedation or analgesia.…”

Section: Introductionmentioning

confidence: 99%

“… 5 No studies have objectively quantified pain during reduction, but it is believed to be painful based on analogies with colonoscopy, where the bowel is also distended with gas and children usually require sedation. 6 In contrast, reduction of ileocolic intussusception is usually performed on awake children without sedation or analgesia. In the United States, only 7% of children with ileocolic intussusception receive sedation during reduction.…”

Section: Introductionmentioning

confidence: 99%

Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception

Poonai,

Cohen,

MacDowell

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceIleocolic intussusception is an important cause of intestinal obstruction in children. Reduction of ileocolic intussusception using air or fluid enema is the standard of care. This likely distressing procedure is usually performed without sedation or analgesia, but practice variation exists.ObjectiveTo characterize the prevalence of opioid analgesia and sedation and assess their association with intestinal perforation and failed reduction.Design, Setting, and ParticipantsThis cross-sectional study reviewed medical records of children aged 4 to 48 months with attempted reduction of ileocolic intussusception at 86 pediatric tertiary care institutions in 14 countries from January 2017 to December 2019. Of 3555 eligible medical records, 352 were excluded, and 3203 medical records were eligible. Data were analyzed in August 2022.ExposuresReduction of ileocolic intussusception.Main outcomes and measuresThe primary outcomes were opioid analgesia within 120 minutes of reduction based on the therapeutic window of IV morphine and sedation immediately before reduction of intussusception.ResultsWe included 3203 patients (median [IQR] age, 17 [9-27] months; 2054 of 3203 [64.1%] males). Opioid use was documented in 395 of 3134 patients (12.6%), sedation 334 of 3161 patients (10.6%), and opioids plus sedation in 178 of 3134 patients (5.7%). Perforation was uncommon and occurred in 13 of 3203 patients (0.4%). In the unadjusted analysis, opioids plus sedation (odds ratio [OR], 5.92; 95% CI, 1.28-27.42; P = .02) and a greater number of reduction attempts (OR, 1.48; 95% CI, 1.03-2.11; P = .03) were significantly associated with perforation. In the adjusted analysis, neither of these covariates remained significant. Reductions were successful in 2700 of 3184 attempts (84.8%). In the unadjusted analysis, younger age, no pain assessment at triage, opioids, longer duration of symptoms, hydrostatic enema, and gastrointestinal anomaly were significantly associated with failed reduction. In the adjusted analysis, only younger age (OR, 1.05 per month; 95% CI, 1.03-1.06 per month; P &lt; .001), shorter duration of symptoms (OR, 0.96 per hour; 95% CI, 0.94-0.99 per hour; P = .002), and gastrointestinal anomaly (OR, 6.50; 95% CI, 2.04-20.64; P = .002) remained significant.Conclusions and RelevanceThis cross-sectional study of pediatric ileocolic intussusception found that more than two-thirds of patients received neither analgesia nor sedation. Neither was associated with intestinal perforation or failed reduction, challenging the widespread practice of withholding analgesia and sedation for reduction of ileocolic intussusception in children.

show abstract

Sedation for Pediatric Gastrointestinal Procedures

Lightdale¹

2014

Pediatric Sedation Outside of the Operating Room

View full text Add to dashboard Cite

Propofol for Pediatric Colonoscopy

Cited by 15 publications

References 12 publications

Study to determine guidelines for pediatric colonoscopy

Study to determine guidelines for pediatric colonoscopy

Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception

Sedation for Pediatric Gastrointestinal Procedures

Contact Info

Product

Resources

About