Pediatric endoscopy

[redy]

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Sorry if this isn't an appropriate place for the question.

My question: does pediatric endoscopy say for 3-4 y/o toddlers have to be under GA or can it be done under procedural sedation?

Thanks a lot.


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[michigangirl]

Depends on the definition of GA-- by anesthesia definitions, the answer is yes, these endoscopies generally have to be done under GA. Doesn't mean you need to intubate, but it's definitely not sedation.

 

[somedumbDO]

Sorry if this isn't an appropriate place for the question.

My question: does pediatric endoscopy say for 3-4 y/o toddlers have to be under GA or can it be done under procedural sedation?

Thanks a lot.


Sent from my iPad using Tapatalk

Well you can do it under deep sedation via propofol without an airway but you have so stick a screaming 3 yr old for an iv. Post op behavioral dysfunctions could come I to play with this approach. You can do things lots of different ways but easiest is po midaz gas plus lma

 

[sevoflurane]

Well you can do it under deep sedation via propofol without an airway but you have so stick a screaming 3 yr old for an iv. Post op behavioral dysfunctions could come I to play with this approach. You can do things lots of different ways but easiest is po midaz gas plus lma

I'd add an IV after mask ind. or LMA. Maybe that is just the way I was trained, but honestly, the two holes in the throat are the esophagus and the VCs. Placement of the endo scope is a blind procedure. If the probe pokes into the VCs + a little reflux you run the risk of having to find an IV quickly. That being said, hypercarbia and anoxia eventually breaks laryngospasm and there is always 5mg/kg of IM sux.

 

[urge]

Placement of the endo scope is a blind procedure.

??? The ones I have seen have always been advanced looking through the scope's camera.

 

[sevoflurane]

I've seen them done both ways. One of our more proficient and busy endoscopists doesn't look up at the monitor until he's entered the esophagus. You are right though. Not all EGD's are done that way.

 

[IlDestriero]

I've heard "sedation" in the GI suite, you want a general for your kid. Trust me. If the parents heard what I heard, they'd probably want to sue.

 

[Spinach Dip]

If you put a kid of <5 years under general anesthesia, why would you NOT intubate them?

 

[IlDestriero]

You don't have to intubate kids for scopes. You can use an LMA or a natural airway with a propofol infusion/boluses. Under 10kg can get tricky with an EGD and no airway. I almost always LMA or tube them under 10kg. I might not for a F/U scope with only esophageal bx planned and no trainees.

 

[bostonblaz]

I mask induce with sevo. Breathe them down until the heart rate starts to slow and then take off the mask and let the gi doc that we do this with pass the scope and do his thing and pull it out and then I wake them up. Just like a BMIC. Blaz

 

[redy]

Thanks for the replies. So I gather while the actual sedation/anesthesia may vary you guys think GA with LMA or tube may be better than sedation.

Thanks again.

 

[David Moss]

Thanks for the replies. So I gather while the actual sedation/anesthesia may vary you guys think GA with LMA or tube may be better than sedation.

Thanks again.

I just want to clarify the common misconception that if you are not using an lma or tube that means you are not giving general anesthesia. I do 98% of these pedi endos under ga with spontaneous ventilation.

 

[redy]

I just want to clarify the common misconception that if you are not using an lma or tube that means you are not giving general anesthesia. I do 98% of these pedi endos under ga with spontaneous ventilation.

Fair enough. Thanks.

 

[ThePlockIsHot]

CA2 here going on my second month of peds, but haven't done much endo. Just curious how you can use an LMA for an upper endoscopy. Can the GIs pass their scope past an LMA?

 

[David Moss]

CA2 here going on my second month of peds, but haven't done much endo. Just curious how you can use an LMA for an upper endoscopy. Can the GIs pass their scope past an LMA?

Yes.

 

[Reciprocity79]

At my residency's children's hospital we routinely do our endoscopies as sevo mask induction, LMA and IV, and maintain with sevo under spontaneous respiration. The GI docs usually don't have trouble passing the scope past the LMA, but you can briefly deflate then reinflate if necessary.

 

[btbam]

We just tube all of them, easier that way.

 

[risnwb]

We usually do mask induction--> iv --> prop Bolus/infusion--> GI goes to town.

We Tube if < 10 kg.

Not sure I see the point of the LMA in these cases. If I'm gonna shove something down there might as well be an et tube.

 

[Maverikk]

Our pediatric ICU docs do procedural sedation with propofol. EMLA cream while they're waiting, PO valium, IV, prop, chin lift.

 

[BIS40]

I did a peds fellowship and am currently in mixed practice. There was a big study at Duke at that time stating LMA was good technique, granted you get GI docs comfortable with it, scope does pass with LMA.
With that said, I do GI at surgery center with a lot of autistic kids and my formula ( they get upper/lower/ pill cam)
Is mask with sevo/ iv 22g placed/ few cc's propofol to relax airway/ ett/ spontaneous vent with 02 and sevo.
They wake up quick and everyone happy airway protected along with fact more secure since they are in lateral position.
Just one way- but it works and safe so it continues.
Of course bigger kids- teens, have got away with sedation like an adult few times as well.
Hey, many ways to skin a cat, rite?

 

[somedumbDO]

We usually do mask induction--> iv --> prop Bolus/infusion--> GI goes to town.

We Tube if < 10 kg.

Not sure I see the point of the LMA in these cases. If I'm gonna shove something down there might as well be an et tube.

Pedi fellowship guy: I have done endo every way imaginable thanks to way too many attendings to count. Large volume pedi scopes day 25+ po midaz mask induction Lma and piv super slick pull deep rescue position have em wake up in pacu. I am home by 1400. Don't knock it till u try it

 

[Mman]

We usually do mask induction--> iv --> prop Bolus/infusion--> GI goes to town.

We Tube if < 10 kg.

Not sure I see the point of the LMA in these cases. If I'm gonna shove something down there might as well be an et tube.

The LMA is like an oral airway. Saves you from having to jaw thrust what is otherwise a mask case and frees up your hands to chart.

 

[risnwb]

Pedi fellowship guy: I have done endo every way imaginable thanks to way too many attendings to count. Large volume pedi scopes day 25+ po midaz mask induction Lma and piv super slick pull deep rescue position have em wake up in pacu. I am home by 1400. Don't knock it till u try it

Well in contrast to you, I have probably done 3 or 4 days of peds endo during residency, and I was definitely not out by 2... So I guess I'll try the lma 😉 , and I'm not a peds fellow...