A Comparison of Moderate Sedation, Deep Sedation and General Anesthesia During Pediatric Endoscopic Procedures: A Multicenter Outcomes Analysis

Abstract

The ideal sedation for pediatric pts having endoscopy remains debatable. Few studies compare complications of deep sedation (DS), moderate sedation(MS)and general anesthesia (GA)in this population. Until more data is available regarding risks vs benefits for the various sedation methods, endoscopists will use the sedation they are most comfortable with. Our aim was to compare sedation and procedure complications associated with the 3 sedation types. Methods: This is a multicenter retrospective review of the medical records of pediatric pts referred for endoscopy between 1/01 and 10/08. Data was collected at SUNY Downstate Medical Center and Winthrop University Hospital(WUH)for pediatric pts receiving either DS(Propofol), MS(Versed/Fentanyl)or GA. All pts received supplemental oxygen and had hemodynamic, respiratory and cardiac monitoring. Pre-procedure, anesthesia, endoscopy, and recovery room records, and subsequent pt follow-up were analyzed. Sedation complications were recorded and defined as systolic(SBP)and/or diastolic blood pressure(DBP)changes of >or< 20 mmHg, apnea >20 seconds, and desaturation <95%. Endoscopic procedure complications were also collected. Procedural and sedation complications were then compared to each type of sedation. Statistical analysis was performed using Chi square test. Results: A total of 875 procedures were enrolled.204 procedures were performed at SUNY;137 upper endoscopies(EGD): 19 with DS,35 MS, and 83 GA; and 67 colonoscopies: 14 DS,22 MS and 31 GA. There was one adverse event observed: a decrease in SBP>20 mmHg in the group of pts who received DS(3%). There were 10 adverse events in the 57 pts who received MS: 9 decreases in both SBP and DBP >than 20 mmHg and one increase in both SBP and DBP >20mmHg. There were 6 adverse events: 2 decreases in both SBP and DBP,2 decreases in SBP,1 decrease in DBP, and 1 increase in DBP, all >20 mmHg, in the 114 pts who received GA. There was one perforation noted during a colonoscopy with GA. There were 671 procedures performed at WUH: 455 EGD's,212 colonoscopies,2 EUS's, and 2 ERCP's. All pts received DS at WUH. There were no sedation complications. There was one perforation during a colonoscopy with DS. There were significantly less sedation complications when using DS as compared to moderate sedation(p<0.0001)and GA (p<0.0001). Conclusions: DS had significantly less sedation complications(0.15%)compared to MS(17.5%)and GA(5.3%). There were no procedure related complications with MS. There was one perforation with GA and one with DS. It appears that pts are at increased risk of perforation with DS/GA methods as opposed to MS. Perhaps this is due to pt's being unable to communicate or express pain during the procedure.