3332 UPPER ENDOSCOPY IN CHILDREN WITHOUT SEDATION.

Abstract

Introduction. In children, upper endoscopy is most often performed with either conscious sedation or general anesthesia; debate persists regarding which is the preferred method. In our experience, some children want to forego sedation because of concerns of prolonged sedative effects and their desire to participate in activities later in the day.We report on the results of our experience with unsedated upper endoscopy in children. Prior to and immediately following upper endoscopy, children rated their level of anxiety (linear scale, max score=10) and degree of pain (face scale, max score=5). All procedures were timed. All patients received topical pharyngeal anesthesia. Patients electing sedation received a combination of meperidine and midazolam, titrated to effect. Results are expressed as mean ± SE. Endoscopy was performed with sedation (Sed) in 9 patients and without sedation ( f Sed) in 6 patients. Patients were of similar age (11.4 ± 1.1 and 12.7 ± 2.4 yrs for Sed and f Sed, respectively). Endoscopy was successfully completed in all Sed patients. Endoscopy failed in 1 of 6 f Sed patients. There was no difference between Sed and f Sed in the pre-endoscopy scores for anxiety (4.52 ± 1.28 vs 2.95 ± 1.6, respectively) and pain (1.69 ± 0.54 vs 2.33 ± 0.66, respectively). In Sed patients a decrease was seen in mean post-endoscopy score, compared to pre-endoscopy score for anxiety (0.84 ± 0.34, p < 0.01) and pain (0.74 ± 0.43, p < 0.05). In f Sed patients an increase was seen in mean post-endoscopy score for anxiety (5.97 ± 1.68) and pain (2.67 ± 0.84); statistical significance was not reached compared to pre-endoscopy score. Anxiety score decreased or remained unchanged in 8 of 9 Sed, but in only 2 of 6 f Sed patients. Pain score decreased or remained unchanged in 8 of 9 Sed patients, and 4 of 6 f Sed patients. No difference was seen in the time to perform endoscopy between Sed (11 ± 1 min) and f Sed (12 ± 1 min). However, the total time a child spent in the endoscopy suite was significantly greater in Sed (89 ± 8 min) than f Sed (37 ± 6 min, p < 0.001), related to a longer recovery time. Conclusion. These preliminary results show that unsedated endoscopy is a viable option for motivated children. Lack of post-sedation somnolence allows children to quickly return to their daily activities. Also, the risk of sedation complications is avoided. Unsedated upper endoscopy should by no means supplant sedated endoscopy in children. However, in selected patients unsedated upper endoscopy can be completed quicker, more safely, and without significant effect on the patient's perception of pain and anxiety.