Experience with an anesthesiologist interventional model for endoscopy in a pediatric hospital

Background: Endoscopy is now a routine part of the work-up for many patient s with gastrointestinal symptoms. Adults tolerate these procedures well, wi th either no sedation or a relatively light level. In contrast, children of ten require deep sedation or a general anesthetic to successfully perform t hese procedures. Therefore, pediatric endoscopies may require more time, pe rsonnel, and monitoring equipment to provide optimal conditions for the pat ient. The goals of this retrospective case series were to describe the anes thesia times and recovery duration of the different procedures, the types a nd amounts of medications commonly used, and the types and rates of complic ations experienced. Methods: Patients (2,306) who underwent endoscopy in the Arkansas Children' s Hospital endoscopy suite during a 4-year period were identified. A random sample of 720 charts was reviewed retrospectively. Results: Patients ranged in age from younger than 1 year to 29 years. Patie nts most often had abdominal pain or multiple gastrointestinal symptoms. Si xty-eight percent of patients underwent esophagogastroduodenoscopies; 30% c olonoscopy or a combination of the two. Ninety-five percent of patients rec eived a propofol-based anesthetic. Midazolam, fentanyl, and alfentanil were frequently used as supplemental agents. Complications occurred infrequentl y and were airway related. All complications were easily treated, with no a dverse sequelae. Conclusions: This model of anesthesiologist-provided sedation/anesthesia fo r gastrointestinal endoscopy procedures has been extremely successful in th e Arkansas Children's Hospital and has served to heighten awareness of many issues surrounding sedation and anesthesia outside of the operating room, while ensuring a high level of care is provided.