Patino Mario, Glynn Susan, Soberano Mark, Putnam Philip, Hossain Md Monir, Hoffmann Clifford, Samuels Paul, Kibelbek Michael J, Gunter Joel
Department of Anesthesiology, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, USA.
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
Paediatr Anaesth. 2015 Oct;25(10):1013-9. doi: 10.1111/pan.12717. Epub 2015 Jul 17.
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.
To evaluate the incidence of respiratory complications (primary aim) and institutional efficiency (secondary aim) among three different anesthetic techniques in children undergoing EGD.
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).
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.
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.
儿童食管胃十二指肠镜检查（EGD）通常在全身麻醉下进行。麻醉目标包括将气道并发症降至最低，同时最大限度地提高手术室（OR）效率。目前，对于哪种麻醉技术最能实现这些目标尚无共识。我们进行了一项前瞻性随机研究，比较三种不同的麻醉技术。
评估接受EGD的儿童中，三种不同麻醉技术的呼吸并发症发生率（主要目的）和机构效率（次要目的）。
受试者接受标准化的吸入诱导麻醉，然后随机分为三组之一：插管七氟醚组（IS）、插管丙泊酚组（IP）和未插管保留自主气道丙泊酚组（NA）。呼吸并发症包括轻度血氧饱和度降低（SpO2在94%至85%之间）、重度血氧饱和度降低（SpO2<85%）、呼吸暂停、气道阻塞/喉痉挛、误吸和/或内镜检查期间麻醉不足。通过检查不同护理阶段（麻醉准备、手术、手术室停留、恢复和围手术期总护理）所花费的时间来评估机构效率。
纳入179名1至12岁儿童（中位数7岁；四分位间距4.0，10.0）（IS组N = 60，IP组N = 59，NA组N = 61）。NA组的呼吸并发症发生率（0.459）高于IS组（0.033）或IP组（0.086）（P<0.0001）。最常观察到的并发症是血氧饱和度降低、麻醉不足和呼吸暂停。三组之间的机构效率没有差异。
NA组呼吸并发症更常见。在EGD期间使用保留自主气道并维持丙泊酚麻醉，在呼吸并发症或机构效率方面并无优势。
