Nitrous oxide sedation in pediatric patients undergoing gastrointestinal endoscopy

Background: The ideal medication to administer to children before gastroint estinal endoscopy procedures has yet to be found. The efficacy of using inh aled nitrous oxide during endoscopy in children was assessed in a pilot stu dy. Methods: Patients aged 5 to 17 years, referred to our hospital for diagnost ic upper gastrointestinal endoscopy or rectosigmoidoscopy procedures, were eligible for enrollment in this study. All received 50% nitrous oxide in ox ygen (Entonox; AGA, Rueil-Malmaison, France) before endoscopy and some of t hem again during endoscopy. The pediatric endoscopist and the nurse perform ing the procedure were separately asked to rate cooperation, emotional stat e, drowsiness and overall efficacy of sedation. Oxygen saturation and adver se effects were recorded throughout the procedure. After endoscopy, childre n scored their degree of pain during the procedures on a visual analog scal e (0, no pain; 100, agony) and on a body outline (projective method). Any a dverse effects were noted. Results: Thirty-seven patients were enrolled in the study. Thirty patients underwent diagnostic upper gastrointestinal endoscopy and seven diagnostic rectosigmoidoscopy. The median time from administration of nitrous oxide un til insertion of the endoscope was 5 minutes (range, 3-8 minutes). Good or excellent efficacy of the sedation was noted in 92% of children by the endo scopist and in 89% by the nurses. Good or excellent cooperation was noted i n 92% of the children by the endoscopist and in 78% by the nurses. The chil dren's pain score on the visual analog scale ranged from 5 to 100(median, 2 0) for upper gastrointestinal endoscopy and from 0 to 30 (median, 0) for re ctosigmoidoscopy. The time of discharge after endoscopy, defined as the tim e elapsed between the end of the endoscopy and discharge from the endoscopy suite, varied from 1 to 7 minutes (median, 1.5 minutes). Conclusion: Entonox provides rapid and effective analgesia without heavy se dation, leads to adequate relaxation and cooperation, and facilitates quick and efficient endoscopy. The effect of Entonox was of short duration, allo wing the children to leave the endoscopy unit without need for a long recov ery period. The adverse effects of Entonox appeared to be minor, and their duration was always brief. Nitrous oxide-oxygen inhalation may provide a va luable alternative to conventional sedation regimens during gastrointestina l endoscopy in children, but randomized and prospective studies comparing n itrous oxide sedation and conventional sedation regimens are necessary.