Pediatric Gastroenterology, Hepatology & Nutrition

  • 제24권1호
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  • Pages.100-108
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  • 2021
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  • 2234-8646(pISSN)
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  • 2234-8840(eISSN)
대한소아소화기영양학회 (The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition)
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Airway Management for Initial PEG Insertion in the Pediatric Endoscopy Unit: A Retrospective Evaluation of 168 Patients

  • Peck, Jacquelin (Department of Anesthesiology, Mount Sinai Medical Center) ;
  • Nguyen, Anh Thy H. (Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital) ;
  • Dey, Aditi (Office of Medical Education, Johns Hopkins All Children's Hospital) ;
  • Amankwah, Ernest K. (Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital) ;
  • Rehman, Mohamed (Pediatric Anesthesiology, Johns Hopkins All Children's Hospital) ;
  • Wilsey, Michael (Pediatric Gastroenterology, Johns Hopkins All Children's Hospital)
  • 투고 : 2020.06.20
  • 심사 : 2020.09.26
  • 발행 : 2021.01.15
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초록

Purpose: Percutaneous endoscopic gastrostomy (PEG) tube placements are commonly performed pediatric endoscopic procedures. Because of underlying disease, these patients are at increased risk for airway-related complications. This study compares patient characteristics and complications following initial PEG insertion with general endotracheal anesthesia (GETA) vs. anesthesia-directed deep sedation with a natural airway (ADDS). Methods: All patients 6 months to 18 years undergoing initial PEG insertion within the endoscopy suite were considered for inclusion in this retrospective cohort study. Selection of GETA vs. ADDS was made by the anesthesia attending after discussion with the gastroenterologist. Results: This study included 168 patients (GETA n=38, ADDS n=130). Cohorts had similar characteristics with respect to sex, race, and weight. Compared to ADDS, GETA patients were younger (1.5 years vs. 2.9 years, p=0.04), had higher rates of severe American Society of Anesthesiologists (ASA) disease severity scores (ASA 4-5) (21% vs. 3%, p<0.001), and higher rates of cardiac comorbidities (39.5% vs. 18.5%, p=0.02). Significant associations were not observed between GETA/ADDS status and airway support, 30-day readmission, fever, or pain medication in unadjusted or adjusted models. GETA patients had significantly increased length of stay (eβ=1.55, 95% confidence interval [CI]=1.11-2.18) after adjusting for ASA class, room time, anesthesia time, fever, and cardiac diagnosis. GETA patients also had increased room time (eβ=1.20, 95% CI=1.08-1.33) and anesthesia time (eβ=1.50, 95% CI=1.30-1.74) in adjusted models. Conclusion: Study results indicate that younger and higher risk patients are more likely to undergo GETA. Children selected for GETA experienced longer room times, anesthesia times, and hospital length of stay.

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참고문헌

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