Esophagogastroduodenoscopy procedure in sick pediatric patients: A comparison between deep sedation and general anesthesia technique

Abstract

Objectives: To compare and evaluate the clinical efficacy of deep sedation and general anesthesia for esophagogastroduodenoscopy (EGD) in sick pediatric patients (ASA physical status ≥ III) in a tertiary care teaching hospital in Thailand. Subjects and methods: We undertook a retrospective review of the anesthesia service records of sick pediatric patients who underwent EGD. All sick pediatric patients were classified into two groups according to the type of anesthetic technique: group DS (deep sedation) and group GA (general anesthesia). The primary outcome variable of the study was the successful completion of the procedure. Failed procedure is defined as the procedure can not be completed by using DS or GA technique or anesthesia-related serious adverse events such as severe hypoxemia (SpO2 < 85% more than 3 minutes and can not relief by airway management), severe cardiorespiratory instability, are occurred. The secondary outcome variables were anesthesia/sedation-related complications during and immediately after the procedure. Results: 101 sick patients underwent EGD procedure during the study period. Premedications were none prior to the procedure. After matching age, gender, weight and indications of procedures, there were 51 patients in group DS and 27 patients in group GA. There were no significant differences in age, gender, weight, ASA physical status and indications of procedures. However, the duration of anesthesia in group GA was significantly longer than in group DS (p= 0.004).All DS and GA techniques were used successfully in all but one in group DS. Mean dose of propofol and fentanyl in both groups was comparable. Overall complication rate in group DS was significantly higher than in group GA (p= 0.039). However, there were no significant differences in the sedation and procedure related complications, anesthetic personnel and mortality rate. Conclusion: In the setting of the developing country, DS and GA for EGD in sick pediatric patients by experienced anesthesiologist with appropriate monitoring were relatively safe and effective. Serious adverse events were rare in our population. © 2012 Amornyotin S et al.