Insufflation vs intubation during esophagogastroduodenoscopy in children

Evaluation of the Explorer Endoscopy Mask(©) for esogastroduodenoscopy in children: a retrospective study of 173 cases

AIMS

The aim of this study was to evaluate the usability and safety of the Explorer Endoscopy Mask(®) (EM) as an alternative to endotracheal intubation in children undergoing elective esogastroduodenoscopy (EGD) under general anesthesia (GA).

METHODS

This study was a retrospective observational study. The study was undertaken at the pediatric digestive endoscopy suite in the Cliniques universitaires Saint-Luc, Brussels, Belgium. We retrospectively analyzed the occurrence of minor and major airway-related adverse effects during pediatric EGD procedures performed under GA with the EM between June 2014 and March 2015.

RESULTS

During the study period, 173 patients underwent EGD. Their mean age was 8.4 years (median: 9.1 years, range 4 months to 16 years). Mean duration of endoscopy (from insertion to removal of the endoscope) was 12.6 min (median: 12 min, range 3-47 min). The use of EM was uneventful in 159 (92%) cases. There were 24 airway-related adverse events in 14 children. Hypoxemia (SpO2 <90%) (13 events, 7.5%) was the most commonly encountered complication followed by laryngo- or bronchospasm (five events, 2.89%), cough (five events, 2.89%), and intubation (one event, 0.58%). No cases of regurgitation/aspiration were observed.

CONCLUSIONS

Our data support the EM use in pediatric EGD. There were few transient respiratory adverse events which were easily solved with minor interventions.

Comparison of different anesthesia techniques during esophagogastroduedenoscopy in children: a randomized trial

BACKGROUND

Esophagogastroduedenoscopy (EGD) in children is usually performed under general anesthesia. Anesthetic goals include minimization of airway complications while maximizing operating room (OR) efficiency. Currently, there is no consensus on which anesthetic technique best meets these goals. We performed a prospective randomized study comparing three different anesthetic techniques.

AIMS

To evaluate the incidence of respiratory complications (primary aim) and institutional efficiency (secondary aim) among three different anesthetic techniques in children undergoing EGD.

METHODS

Subjects received a standardized inhalation induction of anesthesia followed by randomization to one of the three groups: Group intubated, sevoflurane (IS), Group intubated, propofol (IP), and Group native airway, nonintubated, propofol (NA). Respiratory complications included minor desaturation (SpO2 between 94% and 85%), severe desaturation (SpO2 < 85%), apnea, airway obstruction/laryngospasm, aspiration, and/or inadequate anesthesia during the endoscopy. Evaluation of institutional efficiency was determined by examining the time spent during the different phases of care (anesthesia preparation, procedure, OR stay, recovery, and total perioperative care).

RESULTS

One hundred and seventy-nine children aged 1-12 years (median 7 years; 4.0, 10.0) were enrolled (Group IS N = 60, Group IP N = 59, Group NA N = 61). The incidence of respiratory complications was higher in the Group NA (0.459) vs Group IS (0.033) or Group IP (0.086) (P < 0.0001). The most commonly observed complications were desaturation, inadequate anesthesia, and apnea. There were no differences in institutional efficiency among the three groups.

CONCLUSION

Respiratory complications were more common in Group NA. The use of native airway with propofol maintenance during EGD does not offer advantages with respect to respiratory complications or institutional efficiency.

[Oesophago-gastro-duodenoscopy in a teenager and esophageal achalasia]

Oesophago-gastro-duodenoscopy for diagnostic is daily performed in adults and in children during sedation with propofol. This is administrated in France by anaesthesiologists. Pulmonary or cardiovascular complications are rare. We report a case of massive inhalation during an EGD with a teenager. The assessment has revealed an oesophageal achalasia, a condition rare in children and atypical development. This case highlights the importance of systematic screening for risk of a full stomach during the anaesthesia consultation, and the difficulty in evaluation in case of medical migrant patient.