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

Mario Patino; Susan Glynn; Mark Soberano; Philip Putnam; Md Monir Hossain; Clifford Hoffmann; Paul Samuels; Michael J Kibelbek; Joel Gunter

doi:10.1111/pan.12717

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

Paediatr Anaesth. 2015 Oct;25(10):1013-9. doi: 10.1111/pan.12717. Epub 2015 Jul 17.

Authors

Mario Patino¹, Susan Glynn¹, Mark Soberano¹, Philip Putnam², Md Monir Hossain³, Clifford Hoffmann¹, Paul Samuels¹, Michael J Kibelbek¹, Joel Gunter¹

Affiliations

¹ Department of Anesthesiology, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA.
² Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
³ Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

PMID: 26184697
DOI: 10.1111/pan.12717

Abstract

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.

Keywords: airway management; airway obstruction; anesthesia, general; anesthesia, inhalation; anesthesia, intravenous; esophagoscopy.

Publication types

Comparative Study
Randomized Controlled Trial

MeSH terms

Airway Management / methods*
Anesthesia Recovery Period
Anesthesia, General / methods*
Anesthesia, Inhalation / methods*
Anesthesia, Intravenous / methods*
Child
Child, Preschool
Duodenoscopy*
Esophagoscopy*
Female
Humans
Infant
Male
Methyl Ethers
Propofol
Prospective Studies
Sevoflurane

Substances

Methyl Ethers
Sevoflurane
Propofol