1134

Abstract

Introduction: Endoscopic procedures in children and adolescents in the United States are uniformly performed with the patient under some form of sedation. Airway management in children can be challenging as they are more vulnerable to adverse events. Currently, large studies investigating pediatric endoscopy under sedation and adverse events do not exist. The sedation program at Helen DeVos Children’s Hospital (HDVCH) is delivered by pediatric Intensivists who provide non-intubated procedural sedation for large numbers of patients. Here, we evaluate our practice of sedating patients for esophagogastroduodenoscopy (EGDs). Hypothesis: Non-intubated intravenous sedation for pediatric endoscopy is both safe and effective. Methods: Single-center retrospective series of outpatient GI endoscopies performed from January 2008 to December 2011. Following IRB approval, relevant data such as demographic, medication, and adverse event data were obtained from patients’ sedation records. Results: 2314 (998 female) patients were sedated in an outpatient setting for various indications to undergo EGD. Average age was 9.2 ± 4.8 years and Median ASA class was 2 with Mallampati class 1. The main indications for EGD were 762 patients (33%) for dysphagia, 645 patients (28 %) for reflux and 368 (16 %) for eosinophilic esophagitis. The patients were screened by a sedation nurse for suitability for sedation and then by the Attending Intensivist prior to sedation. Propofol was the drug of choice in 2248 (97 %) patients, Methohexital, 60 patients, Ketamine, 4 patients and Versed/Fentanyl, 2 patients. Average propofol administered was 8.7 ± 17.8 mg/kg including and an average of 2.23 ± 1.2 mg/kg induction dose.Recorded Intra-sedation adverse events were 2 patients required intubation, bag/mask ventilation 19/2314 (0.82%) and 1 acute drug reaction. Overall adverse events were separated in those needing prolonged observation 44/ 2314 but discharged same day and those needing at least overnight Hospital stay 3/2314. Conclusions: EGD sedation can be safely delivered in the outpatient setting by a team that has been trained to provide such care in pediatric populations.