Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea.
Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2020 Jun 1;35(21):e183. doi: 10.3346/jkms.2020.35.e183.
Endoscopy is used for diagnosing and treating various digestive diseases in children as well as in adults. However, in pediatric patients, it is recommended that sufficient sedation should be ensured before conducting endoscopy, since insufficient sedation may cause serious complications. However, in Korea, no studies have yet described the types of sedation drugs, effects of sedation, and efficiency of endoscopy with respect to the sedation instructor. Thus, we investigated the effectiveness of sedative procedures performed by anesthesiologists.
We retrospectively reviewed the medical records of patients aged < 18 years who underwent endoscopy during March 2014-July 2019. Data of sedation instructors, sedation drugs and their doses, complications, and the recovery after sedation were evaluated.
Of 257 patients, 217 underwent esophagogastroduodenoscopy (EGD) and 40 underwent colonoscopies. Before EGD, 29 patients (13.4%) underwent sedation by the pediatric endoscopist and 188 (86.6%) were sedated by the anesthesiologist. The anesthesiologist performed the sedation for all 40 patients who underwent colonoscopy. Endoscopic examinations performed by the anesthesiologist were relatively more time-consuming (401.0 ± 135.1 seconds vs. 274.9 ± 106.1 seconds, < 0.001). We observed that in patients who underwent EGD, there was a difference in the dose of midazolam administered ( = 0.000). When comparing EGD and colonoscopy in patients undergoing sedation by the anesthesiologist, there were no significant differences in the doses of midazolam and ketamine, but the dose of propofol increased for colonoscopy (2.50 ± 0.95 mg/kg vs. 4.71 ± 1.66 mg/kg, = 0.000). The cognitive recovery time according to drug dose was associated with propofol only in EGD with a shorter endoscopy time. The longer cognitive recovery time in colonoscopy and the discharge time of EGD and colonoscopies were not associated with propofol use.
When sedation is performed by an anesthesiologist, various drugs are used with sufficient doses and complications are reduced, but the discharge time does not change. For performing pediatric endoscopy in Korea, anesthesiologists should be considered for inducing anesthesia.
内镜检查用于诊断和治疗儿童和成人的各种消化道疾病。然而，在儿科患者中，建议在进行内镜检查前确保充分镇静，因为镇静不足可能会导致严重并发症。然而，在韩国，尚无研究描述过镇静剂的类型、镇静效果以及与镇静指导者相关的内镜检查效率。因此，我们调查了麻醉师实施镇静程序的效果。
我们回顾性分析了 2014 年 3 月至 2019 年 7 月期间接受内镜检查的<18 岁患者的病历。评估了镇静指导者、镇静药物及其剂量、并发症以及镇静后的恢复情况。
在 257 名患者中，217 名患者接受了食管胃十二指肠镜检查（EGD），40 名患者接受了结肠镜检查。在 EGD 之前，29 名患者（13.4%）由儿科内镜医师进行镇静，188 名患者（86.6%）由麻醉师进行镇静。所有 40 名接受结肠镜检查的患者均由麻醉师进行镇静。麻醉师进行的内镜检查耗时相对较长（401.0±135.1 秒比 274.9±106.1 秒，<0.001）。我们观察到，在接受 EGD 的患者中，咪达唑仑的剂量存在差异（=0.000）。当比较接受麻醉师镇静的 EGD 和结肠镜检查患者时，咪达唑仑和氯胺酮的剂量没有显著差异，但结肠镜检查时异丙酚的剂量增加（2.50±0.95mg/kg 比 4.71±1.66mg/kg，=0.000）。根据药物剂量，认知恢复时间仅与 EGD 中较短的内镜时间相关。结肠镜检查中认知恢复时间较长，以及 EGD 和结肠镜检查的出院时间与异丙酚的使用无关。
当由麻醉师进行镇静时，会使用各种药物并给予足够的剂量，从而减少并发症，但出院时间不会改变。在韩国进行儿科内镜检查时，应考虑使用麻醉师进行麻醉诱导。
