UMMS Affiliation

Division of Pediatric Gastroenterology and Nutrition, UMass Memorial Children's Medical Center; Department of Pediatrics; Department of Population and Quantitative Health Sciences

Publication Date

2021-08-11

Document Type

Article

Disciplines

Anesthesia and Analgesia | Anesthesiology | Gastroenterology | Pediatrics

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.

Keywords

anesthesiologist, coefficient of variability, efficiency, endoscopy, pediatric anesthesiology, pediatrics, sedation, variation in care

Rights and Permissions

Copyright © 2021 Hartjes, Dafonte, Lee and Lightdale. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

DOI of Published Version

10.3389/fped.2021.709433

Source

Hartjes KT, Dafonte TM, Lee AF, Lightdale JR. Variation in Pediatric Anesthesiologist Sedation Practices for Pediatric Gastrointestinal Endoscopy. Front Pediatr. 2021 Aug 11;9:709433. doi: 10.3389/fped.2021.709433. PMID: 34458212; PMCID: PMC8385768. Link to article on publisher's site

Journal/Book/Conference Title

Frontiers in pediatrics

Related Resources

Link to Article in PubMed

PubMed ID

34458212

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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