ABSTRACT
Introduction: Upper gastrointestinal studies are routine diagnostic and therapeutic procedures. In pediatrics, however, they are limited by the need for sedation and monitoring. Objectives: Po evaluate sedation, indication, and parent perception of these exams. Patients and Methods: A prospective study of 190 pediatric upper gastrointestinal endoscopies was undertaken. Demographic data, as well as information regarding the exam was obtained. Results: Patients' average age was 8.5 +/- 4.2, mostly referred by pediatricians (60 percent) Main reason for referral was recurrent abdominal pain (29.8 percent). Patients were classified according to ASA criteria (93 percent ASA I and II). Most patients required two or more medications for optimal sedation, with satisfactory procedure in over 90 percent. Over 75.5 percent had complete amnesia, 42.7 percent presented minor discomfort after the procedure. Findings of these procedures included 61 percent of normal exams, 13.9 percent esophagitis. More findings were there result of analyses according to children's weight (over or under 14 kg), age, ASA, reason for referral, nurse's evaluation of sedation. Conclusion: Ambulatory endoscopio procedures can be performed safely in children, with moderate sedation. Requirements are adequate monitoring, and deep knowledge of resuscitation techniques.
Introducción: El estudio endoscópico alto es un procedimiento diagnóstico y terapéutico considerado de rutina, pero su realización en pediatría se encuentra limitada dada la necesidad de sedación y monitoreo adecuados. Objetivos: Evaluar la sedación, indicación y percepción de los padres del examen. Materiales y Métodos: Estudio prospectivo de 190 niños sometidos a endoscopia digestiva alta. Se obtuvieron datos bio-demográficos, tipo de sedación y resultados del examen. Resultados: La edad fue 8,5 + 4,2 años, la mayoría referidos por pediatra (60 por ciento). La principal indicación del estudio fue el dolor abdominal recurrente (29,8 por ciento). Los pacientes fueron clasificados de acuerdo al ASA (93 por ciento ASA I y II). En la mayoría se requirió de 2 ó más drogas para lograr sedación óptima. La calidad del procedimiento fue satisfactoria en más del 90 por ciento. Un 75,5 por ciento presentaron amnesia completa y un 42,7 por ciento molestias leves posterior al procedimiento. Entre los hallazgos destacaron signos de esofagitis en el 13,9 por ciento, observándose un 61 por ciento de los exámenes normales. Al analizar los pacientes por peso (mayores y menores de 14 kg), se encontraron diferencias en edad (p < 0,00001), ASA (p = 0,001), indicación de endoscopia (p = 0,001) y evaluación de la sedación por enfermera (p = 0,038). Conclusión: Procedimientos endoscópicos en niños pueden realizarse de manera segura en forma ambulatoria mediante sedación moderada. Una adecuada monitorización y conocimiento de técnicas de reanimación son básicos al momento de realizar dichos procedimientos.
Subject(s)
Humans , Male , Female , Child , Endoscopy, Digestive System/methods , Pediatrics/methods , Conscious Sedation/methods , Deep Sedation/methods , Age Factors , Endoscopy, Digestive System/statistics & numerical data , Follow-Up Studies , Hypnotics and Sedatives/administration & dosage , Monitoring, Physiologic , Meperidine/administration & dosage , Midazolam/administration & dosage , Prospective Studies , Pediatrics/statistics & numerical dataABSTRACT
Background: Colonoscopy is a well established diagnostic and therapeutic procedure in pediatrics. Aim: To evaluate colon preparation alternatives for colonoscopy or sigmoidoscopy, type of sedation, clinical indications and findings. Patients and methods: Prospective study of 123 children referred for colonoscopy. Demographic data, type of colon preparation, sedation, type of endoscope and endoscopic results were obtained. The following day, a phone interview was carried out inquiring about duration, quality and adverse effects of the sedation and procedure. Results: Seventy one boys (58%) and 52 girls (42%) with a mean age of 6.7±4.4 years, were recruited. The main indication was lower gastrointestinal bleeding (71%). The different colon preparations produced elimination of clear liquid stools in 50%, non transparent liquid in 23%, semi liquid in 22% and solid in 6% of the patients. Most common side effects were abdominal distension (20%) and nausea (16.8%). The most commonly used drugs were midazolam (76%) and demerol (43%). The average duration of the procedure was 18.3 minutes (range: 4-50). The most common findings were rectal polyps (18.7%) and hemorrhagic colitis (14.6%). In 77% of cases, the sedation was considered very good or good. Colon visualization was described as very good (51%) or good (36%). Seventy three percent of children had complete amnesia. The most common adverse effect was vomiting (7.5%). Conclusion: Lower endoscopies are feasible procedures to carry out in children, in an ambulatory basis, with intravenous sedation and minimum adverse effects.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Colonoscopy/standards , Outcome and Process Assessment, Health Care , Postoperative Care/standards , Preoperative Care/standards , Administration, Oral , Administration, Rectal , Analysis of Variance , Colonoscopy/adverse effects , Enema/adverse effects , Gastrointestinal Hemorrhage/surgery , Patient Satisfaction , Postoperative Care/adverse effects , Preoperative Care/adverse effects , Prospective Studies , Sigmoidoscopy/adverse effects , Sigmoidoscopy/standardsABSTRACT
Se describen dos pacientes, una de 7 años con eritema multiforme mayor o síndrome de Stevens-Johnson y otra de 6 años con necrólisis epidérmica tóxica, atribuidos a carbamazepina. En ambas niñas se encontró disminución reversible de la concentración de inmunoglobulinas séricas, que fue severa en la paciente con necrólisis epidérmica tóxica (IgG390 mg por ciento. IgM 20 mg por ciento. IgA 22 mg por ciento). La asociación de eritema multiforme mayor y necrólisis epidérmica tóxica, desncadenados por carbamazepina, con hipogamaglobulinemia ha sido escasamente comunicada en trabajos previos y se ha postulado la participación del sistema inmune en su patogenia