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Abstract

Introduction: Procedural sedation (PS) on pediatric patients outside the OR setting have increased in the past 20 years, and as a consequence of this change, institutions have adopted sedation polices that create pediatric sedation units, exclusively for children, to enhance patient safety and satisfaction.The importance of sedation during endoscopy is well established, but there is no consensus about the best techniques for sedation, which specialist should perform it, and in which location. To address all the issues mentioned above, we at the Children’s Hospital at Saint Peter’s University Hospital established a pediatric sedation unit (PSU) in 2004 with a dedicated sedation nurse and pediatric intensivist to provide PS safely and efficiently. The Saint Peters pediatric sedation service provides 100% of all sedations outside the operating room including deep sedation for GI endoscopic procedures. Hypothesis: Based on our experience, we hypothesize that deep sedation for pediatric GI endoscopic procedures can be provided safely using intravenously administered agents, such as Propofol, by non-anesthesiologists (NA) outside the OR. Methods: In our retrospective chart study with consecutive data, children admitted between 2004 and 20102 to the Children’s Hospital at Saint Peter’s University Hospital who underwent upper and lower GI endoscopic procedures for various reasons were extracted. Patients were identified by using the CPT Codes for EGD and colonoscopy. Clinical and patient data, such as sex, age, duration, and sedative used, along with any complications were logged and used for the study.Complications were defined as occurrences that warranted intervention and were classified as hypotension, desaturation, bradycardia, hypertension, arrhythmia, aspiration, respiratory depression, hypoglycemia,cardiac arrest, and/or respiratory arrest. Results: A total1491 patients were identified, of whom 989 (188 for esophageal foreign body (EFB) removal) underwent upper endoscopic procedures and the other 485 underwent colonoscopies. A flexible endoscope was used in all but one patient who had esophageal mucosal erosion due to a button battery which necessitated a rigid endoscopy under general anesthesia. Propofol was the most used drug. Complications were rare (2.6%).Transient hypotension and desaturation were the main adverse events noted during the review. A total of six patients had AI, of whom five had EFB and one known seizure patient had an episode of epilepsy during the procedure. Conclusions: Deep sedation for pediatric GI endoscopic procedures can be provided safely using intravenously administered agents by NA outside the traditional OR.