Table_1_Outcomes of Non-anesthesiologist-Administered Propofol in Pediatric Gastroenterology Procedures.docx

Background and Aims: Non-anesthesiologist-administered propofol (NAAP) has been found to have an acceptable safety profile in adult endoscopy, but its use remains controversial and pediatric data is limited. Our aim was to examine the safety and efficacy of NAAP provided by pediatric hospitalists in pediatric endoscopy.Methods: We retrospectively reviewed 929 esophagogastroduodenoscopy (EGD), colonoscopy, and combined EGD/colonoscopy cases in children aged 5–20 years between April 2015 and December 2016 at a large children's hospital. We analyzed the data for adverse events in relation to demographics and anthropometrics, American Society of Anesthesiologists physical classification score, presence of a trainee, comorbid conditions, and procedure time.Results: A total of 929 cases were included of which 496 (53%) were completed with NAAP. Seventeen (3.4%) of NAAP cases had an adverse event including the following: 12 cases of hypoxia, 2 cardiac, and 3 gastrointestinal adverse events. General anesthesia cases had 62 (14.3%) adverse events including the following: 54 cases of hypoxia, 1 cardiac, 7 gastrointestinal, and 1 urologic adverse event. No adverse events in either group required major resuscitation. NAAP vs. general anesthesia had a lower overall adverse event rate (3.4 vs. 14.3%, p < 0.0004) and respiratory adverse event rate (2.4% vs. 12.5%, p < 0.0004). Overall, cardiac and gastrointestinal adverse event rates between the two groups were comparable. When accounting for all captured factors via logistic regression, both younger age (P < 0.001) and general anesthesia (P < 0.0001) remained risk factors for an adverse event.Conclusion: The overall adverse event rate of NAAP was low (3.4%) with none requiring major resuscitation or hospitalization. This is comparable to studies of NAAP in adult endoscopy and suggests that NAAP provided by pediatric hospitalists has an acceptable safety profile.

背景与目标：非麻醉医师施行的丙泊酚（NAAP）在成人内镜检查中已被证明具有可接受的安全性特征，但其应用仍存在争议，且针对儿科的数据有限。本研究旨在评估儿科住院医师在儿科内镜检查中提供的NAAP的安全性及有效性。方法：我们对2015年4月至2016年12月期间在一所大型儿童医院进行的929例食管胃十二指肠镜（EGD）、结肠镜检查以及联合EGD/结肠镜检查的儿童病例（年龄为5至20岁）进行了回顾性审查。我们分析了与人口统计学和体格测量学、美国麻醉医师协会身体分类评分、实习医师的存在、合并症以及手术时间相关的数据以确定不良事件。结果：共纳入929个病例，其中496例（占53%）使用NAAP完成。17例（占3.4%）的NAAP病例发生了不良事件，包括以下情况：12例低氧血症，2例心脏不良事件和3例胃肠道不良事件。全身麻醉病例中有62例（占14.3%）不良事件，包括以下情况：54例低氧血症，1例心脏不良事件，7例胃肠道不良事件和1例泌尿系统不良事件。两组中均无不良事件需要重大复苏。与全身麻醉相比，NAAP的不良事件总体发生率（3.4% vs. 14.3%，p < 0.0004）和呼吸不良事件发生率（2.4% vs. 12.5%，p < 0.0004）均较低。总体而言，两组间的心脏和胃肠道不良事件发生率相当。在考虑所有通过逻辑回归捕获的因素时，年龄较小（P < 0.001）和全身麻醉（P < 0.0001）仍然是发生不良事件的危险因素。结论：NAAP的总体不良事件发生率较低（3.4%），无一例需要重大复苏或住院治疗。这与成人内镜检查中NAAP的研究结果相当，表明儿科住院医师提供的NAAP具有可接受的安全性特征。