Data_Sheet_2_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实具有可接受的安全性特征，但其应用仍存在争议，且在儿科方面的数据有限。本研究旨在探讨儿科住院医师在儿科内镜检查中提供的NAAP的安全性和有效性。
方法：我们对2015年4月至2016年12月期间在一家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EGD/结肠镜联合检查病例进行了回顾性分析，这些病例的患者年龄在5至20岁之间。我们分析了与人口统计学和体格测量学、美国麻醉医师协会的身体分类评分、实习生存在与否、合并症以及手术时间相关的不良事件数据。
结果：共纳入929例病例，其中496例（53%）完成了NAAP。17例（3.4%）的NAAP病例出现了不良事件，包括以下情况：12例缺氧、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（14.3%）的不良事件，包括以下情况：54例缺氧、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。NAAP与全身麻醉相比，总体不良事件发生率（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，两组间的循环和胃肠道不良事件发生率相当。通过逻辑回归对所有捕获的因素进行分析，年龄较小（P < 0.001）和全身麻醉（P < 0.0001）仍然是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%），且无病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。