Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 25, 2015; 7(9): 895-911
Published online Jul 25, 2015. doi: 10.4253/wjge.v7.i9.895
Review on sedation for gastrointestinal tract endoscopy in children by non-anesthesiologists
Rok Orel, Jernej Brecelj, Jorge Amil Dias, Claudio Romano, Fernanda Barros, Mike Thomson, Yvan Vandenplas
Rok Orel, Jernej Brecelj, Children’s Hospital, University Medical Centre Ljubljana, and Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
Jorge Amil Dias, Department of Pediatrics, Hospital S. João, 4202-451 Porto, Portugal
Claudio Romano, Pediatric Department, University of Messina, 98122 Messina, Italy
Fernanda Barros, Chair of the Paediatric Section of the Portuguese Society of Anaesthesiology, Department of Anesthesiology, Hospital S. João, 4202-451 Porto, Portugal
Mike Thomson, Centre for Paediatric Gastroenterology, International Academy of Paediatric Endoscopy Training, Sheffield Children’s Hospital, Weston Bank, Sheffield S10 2TH, United Kingdom
Yvan Vandenplas, Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
Author contributions: Orel R and Brecelj J performed search through the literature; Orel R, Brecelj J, Dias JA, Romano C, Barros F, Thomson M and Vandenplas Y wrote the paper and made final approval of the version to be published.
Conflict-of-interest statement: None of the authors reported a conflict of interest related to this article. There was no funding. Rok Orel has participated as a clinical investigator or speaker with Medis, Nutricia, Ewopharma, Biogaia, United Pharmaceuticals, Danone, Abbvie, and MSD. Jernej Brecelj has participated as a speaker for MSD and has received travel grants from Abbvie, MSD and Dr. Falk Foundation. Jorge Amil Dias received honoraria for lectures from MJN, Danone, MSD, Abbvie, Falk, and participated in Advisory boards for MSD, Abbvie, Receptos. Claudio Romano did not report any potential conflict of interests. Fernanda Barros has been a clinical investigator for MSD and speaker for B-Braun. Mike Thomson has participated as a clinical investigator, and/or advisory board member, and/or consultant, and/or speaker for Danone/Nutricia, Mead Johnson, Movetis, Nestle, Norgine, Reckitt-Benckieser and Sandhill Scientific. Yvan Vandenplas has participated as a clinical investigator, and/or advisory board member, and/or consultant, and/or speaker for Abbott Nutrition, Aspen, Biogaia, Biocodex, Danone, Hero, Nestle Nutrition Institute, Nutricia, Mead Johnson Nutrition, Merck, Orafti, Phacobel, Sari Husada, United Pharmaceuticals, Wyeth and Yakult.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yvan Vandenplas, MD, PhD, Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium. yvan.vandenplas@uzbrussel.be
Telephone: +32-24-775780 Fax: +32-24-775783
Received: April 3, 2015
Peer-review started: April 8, 2015
First decision: April 27, 2015
Revised: June 5, 2015
Accepted: June 18, 2015
Article in press: June 19, 2015
Published online: July 25, 2015
Processing time: 122 Days and 14.8 Hours
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: Gastro-intestinal endoscopy, Gastroscopy, Colonoscopy, Sedatives, Pediatric ages, Anesthetics, Analgesics

Core tip: Sedation for pediatric gastro-intestinal endoscopy is preferably performed by pediatric anesthesiologists, as part of a multidisciplinary team. However, in many hospitals pediatric anesthesiology is insufficiently developed. The creation of sedation teams led by non-anesthesiologists and a careful selection of anesthetic drugs may offer an effective and safe alternative. These teams should be in line with national legislation and institutional regulations. This paper will help non-anesthesiologists to provide as good-as-possible sedation for children undergoing endoscopy. Practical protocols were developed providing up-to-date information on the most effective and most safe options.