COMPLICATIONS OF INTRAVENOUS DEEP SEDATION IN PEDIATRIC ENDOSCOPY

Objective: It is accepted that sedation during endoscopic procedures is mandatory in children, however the mode of sedation and choice of medication varies among gastroenterologists. The use of intravenous sedation in pediatric endoscopy offers a safe and effective way of either conscious or deep sedation.Methods: In order to investigate the safety and efficacy of intravenous sedation with meperidine and midazolam in pediatric patients, 120 patients who underwent endoscopy were evaluated. Vital signs and any reaction to sedative agents were noted during and after the endoscopic procedure.Results: The complication rate of sedation with this combination was 19.1%, and all were transient with no residual sequelae. The most common complication was allergic skin reactions (15.7%). Transient hypoxia was seen in 1.7% of patients. The recovery time was 74.8±15.8 min. The endoscopic procedure was not postponed in any of the patients due to the complication of sedation.Conclusion: It was concluded that intravenous deep sedation with meperidine and midazolam when administered by an experienced pediatric gastroenterologist and monitored closely is safe and effective with a low risk of complication.Key Words: Sedation, Pediatric endoscopy

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Gleason WA, Tedesco FJ, Keating JF, Goldstein FD. Fiberoptic gastrointestinal endoscopy in infants and children. J Fediatr 1974;85:810-813.
Gryboski JD. The value of upper gastrointestinal endoscopy in children: Dig Dis Sci 1981;26:17-21.
Intravenous deep sedation in pediatric endoscopy
Amnet ME, Christie DL. Upper gastrointestinal fiberoptic endoscopy in pediatric patients. Gastroenterology 1977;71:1244-i248.
Benaroch LM, Rudolph CD. Introduction to pediatric esophagogastroduodenoscopy and enteroscopy. Gastrointest Endosc Clin north Am I994;4:I2I- 142.
Okeffe EB, OConnar RW. ASGE survey of endoscopic sedation and monitorization. Gastrointest Endosc 1990;36:13-18.
Arrowsmith JB, Gertsman BB, Fleischer DE, Benjamin SB. Results of the American Society for Gastrointestinal Endoscopy / U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc 1991;37:421-427.
Bauchner FI. Pylori procedures, pain and parents. Pediatrics 1991;87:563-565.
American Academy of Pediatrics Committee on Drugs. Guidelines on monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. Pediatrics 1992;89:1110-1115.
Amnet ME, Brill JE. Pediatric endoscopy, deep sedation, conscious sedation and general anesthesia - what is best? Gastrointest Endosc 1995;41:173-175.
Squires R, Morriss F, Schluterman S, Drews B, Galyen L, Brown KO. Efficacy, safety, and cost of intravenous sedation versus general anesthesia in children undergoing endoscopic procedures. Gastrointest Endosc 1995;41:99-104.
Ertem D, Acar Y, Özgüven E, Pehlivanoğlu E. Sedation for procedures. Pediatrics 1997,100: 1045-1046.
Bahal-O'mara PI, Piahato MC, Murray RD, et at.
EfFicacy of diazepam and meperidine in ambulatory pediatric patients undergoing endoscopy: a
randomized double blind trial. J Pediatr Gastroentorol Piutr 1993; 16:387-392.
Chuang E, Wenner WJ, Piccoli DA, Altschuler SM, Liacouras CA. Intravenous sedation in pediatric gastrointestinal endoscopy. Gastrointest Endosc 1995,42:156-160.
Sibal A, Davidson S, Murphy MS. high dose
midazolam / meperidine sedation for pediatric endoscopy (abstr). Gastroenterology
; 110:A39.
hassal E. Should pediatric gastroenterologists be
i.v. drug users? J Pediatr Gastroenterol hutr 1993;16:370-372.
Ellett ML. General anesthesia: an alternative to sedation for pediatric endoscopic procedures. Gastroenterol Plurs 1991; 13:166-168.
Ginsberg GG, Lewis Jh, Gallagher JE, et al. Diazepam versus midazolam for colonoscopy: a prospective evaluation of predicted versus actual dosing requirements. Gastrointest Endosc 1992;38:651-665
Tolia V, Brennan S, Aravind MR, Rauffman RE.
Pharmacokinetic and pharmacodynamic study of midazolam in children during
esophagogastroduodenoscopy. J Pediatr 1991; 119:467-471.
Salonen M, Ranto J, Lisalo E, et al. Midazolam as an induction agent in children: a pharmacokinetic and clinical study. Anesth Analg 1987:66:625-628.
Ament ME. Prospective study of risks of complication in 6424 procedures in pediatric gastroenterology. Pediatr Res 1981; 15:524-529.