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. 2015 Jul 25;7(9):895-911.
doi: 10.4253/wjge.v7.i9.895.

Review on sedation for gastrointestinal tract endoscopy in children by non-anesthesiologists

Rok Orel  1 , Jernej Brecelj  1 , Jorge Amil Dias  1 , Claudio Romano  1 , Fernanda Barros  1 , Mike Thomson  1 , Yvan Vandenplas  1
Affiliations

Review on sedation for gastrointestinal tract endoscopy in children by non-anesthesiologists

Rok Orel et al. World J Gastrointest Endosc. .

Abstract

Aim: To present evidence and formulate recommendations for sedation in pediatric gastrointestinal (GI) endoscopy by non-anesthesiologists.

Methods: The databases MEDLINE, Cochrane and EMBASE were searched for the following keywords "endoscopy, GI", "endoscopy, digestive system" AND "sedation", "conscious sedation", "moderate sedation", "deep sedation" and "hypnotics and sedatives" for publications in English restricted to the pediatric age. We searched additional information published between January 2011 and January 2014. Searches for (upper) GI endoscopy sedation in pediatrics and sedation guidelines by non-anesthesiologists for the adult population were performed.

Results: From the available studies three sedation protocols are highlighted. Propofol, which seems to offer the best balance between efficacy and safety is rarely used by non-anesthesiologists mainly because of legal restrictions. Ketamine and a combination of a benzodiazepine and an opioid are more frequently used. Data regarding other sedatives, anesthetics and adjuvant medications used for pediatric GI endoscopy are also presented.

Conclusion: General anesthesia by a multidisciplinary team led by an anesthesiologist is preferred. The creation of sedation teams led by non-anesthesiologists and a careful selection of anesthetic drugs may offer an alternative, but should be in line with national legislation and institutional regulations.

Keywords: Analgesics; Anesthetics; Colonoscopy; Gastro-intestinal endoscopy; Gastroscopy; Pediatric ages; Sedatives.

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Figures

Figure 1
Figure 1
Flow chart of propofol sedation protocol for paediatric gastrointestinal endoscopy. 1Older than 1 mo, without contraindications (egg or soy allergy); 2Diagnostic endoscopy or procedure for which no endotracheal intubation is needed; 3The team qualified for paediatric sedation for gastrointestinal endoscopy.
Figure 2
Figure 2
Flow chart of ketamine sedation protocol for paediatric gastrointestinal endoscopy. 1Older than 3 mo, without contraindications (severe cardiovascular disease, malignant hypertension, CSF obstructive states, intraocular pressure pathology, psychotic illness, hyperthyroidism or thyroid medicines use, and porphyria); 2Diagnostic endoscopy or procedure for which no endotracheal intubation is needed; 3The team qualified for paediatric sedation for gastrointestinal endoscopy.
Figure 3
Figure 3
Flow chart of opioid and benzodiazepine sedation protocol for paediatric endoscopy. 1Patient without contraindications (not being simultaneously treated with monoamine oxidase inhibitors); 2Diagnostic endoscopy or procedure for which no endotracheal intubation is needed; 3The team qualified for paediatric sedation for gastrointestinal endoscopy.
See this image and copyright information in PMC

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