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Minerva Pediatrics 2021 February;73(1):15-21

DOI: 10.23736/S2724-5276.16.04758-7

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Respiratory adverse events during upper digestive endoscopies in children under ketamine sedation

José C. FLORES-GONZÁLEZ 1 , Alfonso M. LECHUGA-SANCHO 2, 3, Mónica SALDAÑA VALDERAS 4, Gema JIMENEZ GOMEZ 5, María D. CRUZADO GARCÍA 1, Cristina PÉREZ ARAGÓN 6, Jose A. BLANCA GARCÍA 6

1 Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain; 2 Department of Mother and Child Health, University of Cadiz, Cadiz, Spain; 3 Department of Radiology, University of Cadiz, Cadiz, Spain; 4 Unit of Clinical Farmacology, Puerta del Mar University Hospital, Cadiz, Spain; 5 Research Unit, Puerta del Mar University Hospital, Cadiz, Spain; 6 Unit of Pediatric Gastroenterology, Puerta del Mar University Hospital, Cadiz, Spain



BACKGROUND: There is no evidence of the need for oxygen supplementation during upper digestive endoscopies under ketamine sedation in children, and the latest recommendations specifically state that it is not mandatory for the procedure. The aim of our study is to assess the incidence of respiratory adverse events during upper digestive endoscopies in children under Ketamine sedation when performed without oxygen supplementation, in accordance with the latest recommendations.
METHODS: Eighty-eight children undergoing ketamine sedation for programmed upper digestive endoscopy at our Pediatric Intensive Care Unit were included. Patients needing other sedative agents different from ketamine were excluded. No patients received previous oxygen therapy. Suction equipment, oxygen, a bag-valve-mask, and age-appropriate equipment for advanced airway management were immediately available. The primary outcome measure was the incidence of desaturation episodes (i.e. FiO2 below 90% requiring an intervention).
RESULTS: Fifty-five patients (62.5%) presented a desaturation episode during the procedure. Most desaturation episodes occurred during the endoscope introduction (78.2%), and 5 episodes were previous to the endoscope introduction (minute 0). Around sixty percent of patients (58.9%) required oxygen therapy and four patients required bag-mask ventilation. Once oxygen therapy was initiated, 34 patients (70.5%) required it during the complete procedure or part of it.
CONCLUSIONS: Desaturation episodes occur frequently early on in the procedure. Our data suggest that the role of oxygen supplementation prior to, and during upper digestive endoscopies under ketamine sedation in children should be thoroughly assessed for future recommendations.


KEY WORDS: Ketamine; Endoscopy, gastrointestinal; Oxygen inhalation therapy

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