Variation in Pediatric Anesthesiologist Sedation Practices for Pediatric Gastrointestinal Endoscopy.

Kayla T Hartjes,Tracey M Dafonte,Jenifer R Lightdale,Austin F Lee

doi:10.3389/fped.2021.709433

Abstract

Background: Despite a worldwide shift toward anesthesiologist-administered sedation for gastrointestinal endoscopy in children, ideal sedation regimens remain unclear and best practices undefined.Aim: The aim of our study was to document variation in anesthesiologist-administered sedation for pediatric endoscopy. Outcomes of interest included coefficients of variation, procedural efficiency, as well as adverse events.Methods: IRB approval was obtained to review electronic health records of children undergoing routine endoscopy at our medical center during a recent calendar year. Descriptive and multivariate analyses were used to examine predictors of sedation practices.Results: 258 healthy children [2–21 years (median 15, (Q1–Q3 = 10–17)] underwent either upper and/or lower endoscopies with sedation administered by anesthesiologists (n = 21), using different sedation regimens (29) that ranged from a single drug administered to 6 sedatives in combination. Most patients did not undergo endotracheal tube intubation for the procedure (208, 81%), and received propofol (255, 89%) either alone or in combination with other sedatives. A total of 10 (3.8%) adverse events (9 sedation related) were documented to occur. The coefficient of variation (CV) for sedation times was high at 64.2%, with regression analysis suggesting 8% was unexplained by procedure time. Multivariable model suggested that longer procedure time (p < 0.0001), younger age (p < 0.0001), and use of endotracheal tube intubation (p = 0.02) were associated with longer sedation time.Discussion: We found great variation in anesthesiologist administered regimens for pediatric endoscopy at our institution that may be unwarranted, presenting may opportunities for minimizing patient risk, as well as for optimizing procedural efficiency.

Highlights

Over the past 2 decades, the landscape of sedation practices for pediatric endoscopy has shifted toward anesthesiologistadministration, despite no single sedative or regimen yet to be established as ideal [1,2,3]
258 healthy children [2–21 years (median 15, (Q1–Q3 = 10–17)] underwent either upper and/or lower endoscopies with sedation administered by anesthesiologists (n = 21), using different sedation regimens [29] that ranged from a single drug administered to 6 sedatives in combination
The coefficient of variation (CV) for sedation times was high at 64.2%, with regression analysis suggesting 8% was unexplained by procedure time

Summary

Introduction

Over the past 2 decades, the landscape of sedation practices for pediatric endoscopy has shifted toward anesthesiologistadministration, despite no single sedative or regimen yet to be established as ideal [1,2,3]. Pediatric endoscopic sedation has been administered by endoscopists or anesthesiologists, and is generally considered necessary for children to undergo procedures [4]. Anesthesiologists differ from endoscopists in their regulatory license to use propofol and inhalational anesthetics, as well as to aim for deep levels of sedation or general anesthesia [17, 18]. Anesthesiologists may be more equipped to administer sedation regimens that can assure children will tolerate endoscopic procedures, without exhibiting agitation, vocalization and disruptive movements [6]. Anesthesiologist-administration has not decreased the occurrence of sedation related adverse events in children undergoing upper and lower endoscopy [19, 20]. Despite a worldwide shift toward anesthesiologist-administered sedation for gastrointestinal endoscopy in children, ideal sedation regimens remain unclear and best practices undefined

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