Sedation of the pediatric and adolescent patient for GI procedures

Abstract

There remains no ideal sedative for pediatric and adolescent patients undergoing gastrointestinal procedures. Instead, pediatric gastroenterologists must consider many factors, including patient age, medical history, clinical status, anxiety level, as well as targeted sedation level, to select the appropriate methods and agents to achieve optimal sedation for endoscopy. The two primary types of sedation are endoscopist-administered intravenous (IV) sedation and anesthesiologist-administered general anesthesia. If IV sedation is used, pediatric endoscopists must be prepared for children to become agitated, adding to stress for both patients and clinical staff. General anesthesia provides the advantage of complete patient immobility but also entails increased costs and utilization of hospital resources. Technical advances in electronic monitoring, both in the pediatric endoscopy suite and operating room settings, are contributing to increased patient safety. Nevertheless, sedation-related events, independent of type of sedation or regimen, represent the most common complications of pediatric endoscopy.

A 3-Year Review of an Outpatient Burn Sedation Program in a Tertiary Burn Care Centre: Is It Safe and Does It Work?

“…6 The authors conclude that the use of general anesthesia may be safer than procedural sedation for the treatment of pediatric patients with burn; however, there is no direct evidence to suggest this, as the studies quoted to favour the use of general anesthesia over procedural sedation have been conducted in patients undergoing sedation for imaging or endoscopy. 6 -9,13…”

“…Recently, the use of general anesthesia for the application of burn dressings in the OR has been shown to be associated with few adverse events 6 ; however, it may not be practical for the dressing or physiotherapy component. There is some evidence to suggest that general anesthesia compared to sedation may be safer in children, [6][7][8][9] but the majority of these studies comparing sedation and general anesthesia were reported for pediatric gastrointestinal procedures. 7,9 Although there is literature supporting outpatient burn care, 1,2 specific data on the safety of the outpatient sedation component are lacking.…”

“…There is some evidence to suggest that general anesthesia compared to sedation may be safer in children, [6][7][8][9] but the majority of these studies comparing sedation and general anesthesia were reported for pediatric gastrointestinal procedures. 7,9 Although there is literature supporting outpatient burn care, 1,2 specific data on the safety of the outpatient sedation component are lacking. This study aimed to examine the safety of sedation in the ward-based burn treatment room at our institution.…”

“…There is some evidence to suggest that general anesthesia compared to sedation may be safer in children, 6 -9 but the majority of these studies comparing sedation and general anesthesia were reported for pediatric gastrointestinal procedures. 7,9…”

A Pilot Study of Ketamine versus Midazolam/Fentanyl Sedation in Children Undergoing GI Endoscopy

“…While many pediatric endoscopists report performing all of their procedures with general anesthesia, approximately a third continue to report administering moderate sedation [2] using a variety of endoscopist-administered sedation regimens [3, 4]. Many institutions use a sedation regimen that combines a narcotic with a benzodiazepine.…”