Procedural sedation protocols with or without ketamine in pediatric gastrointestinal endoscopy: A retrospective cohort study

Objective: A considerable difference exists in pediatric endoscopy sedation practices with the optimal sedation protocol for gastrointestinal (GI) endoscopy a subject of controversy and to investigate the safety and efficacy of sedation protocols with or without ketamine in procedural sedation for pediatric GI endoscopy. Materials and Methods: A total of 78 pediatric patients who received sedation anesthesia for GI endoscopy were included in this retrospective study. Anesthesia parameters include duration time, doses of anesthetic agents, Ramsay sedation score, respiratory and hemodynamic parameters, recovery time, modified Aldrete recovery scores, and side effects. Study parameters were evaluated with respect to ketamine dose (no ketamine group (NKG), low-dose ketamine group (LDKG, ≤0.75 mg/kg), and high-dose ketamine group (HDKG, ≥1 mg/kg). Results: The upper GI endoscopy rate (58.12% vs. 90.0%, p=0.001) was significantly lower in LDKG versus HDKG. No significant changes were observed in blood pressure levels, oxygen saturation, or heart rate compared to baseline levels. No significant difference was noted between study groups in terms of recovery time, modified Aldrete recovery scores, and nausea/vomiting. Final Ramsay sedation scores were significantly higher in NKG (p<0.05) and LDKG (p<0.01) than in HDKG. Conclusion: Our findings indicate a favorable safety and efficacy profile for ketamine as a useful adjunct to procedural sedation for pediatric GI endoscopy, enabling better quality of sedation with a low risk of cardiorespiratory suppression, or serious complications

Frequency of complications due to sedation in patients undergoing gastrointestinal endoscopy

Aim: Non-operating room anesthesia is frequently used in all areas. Gastrointestinal endoscopy is one of the procedures requiring sedation outside the operating room. This study aimed to investigate the drugs used for sedation and the complications during gastrointestinal procedures in our hospital.Materials and Methods: The files of the patients who underwent anesthesia for gastrointestinal endoscopy between 01.01.2018-31.12.2018 in our hospital were retrospectively reviewed. ASA score, age, gender, vital signs, drugs, doses, complications, and need for intensive care were evaluated.Results: A total of 508 patients were sedated. The 187 cases (36.3%) were male, and 321 (63.2%) were female. The mean age was 54.9 ± 15.6 years. Two hundred fifty-two cases (49.6%) were found to be ASA II. Colonoscopy was performed in 134 cases (26.4%), gastroscopy in 270 cases (53.1%), both colonoscopy and gastroscopy in 99 cases (19.5%), and PEG in 5 cases (1%). The most frequently used anesthetic drug in sedated patients was observed to be propofol. Complications occurred in 28 patients (5.5%).Conclusions: Drug selection becomes crucial in non-operating room anesthesia applications in terms of early recovery and patient safety. In this study, it was seen that the most used drug was propofol, and accordingly, it was concluded that mortal complications were not observed

A single tertiary center outcomes on cannulation strategies and extracorporeal membrane oxygenation in the treatment of respiratory failure during COVID-19 infection

Aim: Extracorporeal membrane oxygenation (ECMO) is an important option for the management of severe acute respiratory distress syndrome (ARDS) in Coronavirus disease-2019 (COVID-19) cases. We aimed to present our experiences of ECMO in patients with respiratory failure secondary to COVID-19. Methods: Data of 22 consecutive COVID-19 patients with severe respiratory failure whom were supported with ECMO were collected from computer-based hospital software retrospectively. Patients were treated in a single medical center between April 23, 2020 and February 14, 2021. Patients were analyzed from the points of laboratory and inflammatory markers, ventilation and ECMO features. Results: The ages of patients were between 30 and 69 years (mean age: 56.3±10.63). All patients were under maximum ventilator support, with the prone position. All patients had elevated levels of inflammatory indicators as D-dimer and ferritin. The mean level of ferritin was 1, 564±1, 611 ng/mL. D-dimer value was maximum 10.000 mg/mL (mean: 5, 215±3, 104), CRP increased to 177 mg/L (mean: 159±71). Percent of lymphocytes decreased as low as 2% (mean: 4.16±2.10). The mean duration of veno-arterial (VA) ECMO was 1.6±0.94 days whereas, for veno-venous (VV) ECMO, it was 10.05±5 days. VA ECMO was decided due to cardiovascular collapse. Four patients with VA ECMO survived a maximum of 3 days. Four of (22.22%) of 18 VV ECMO supported patient’s blood gas values were at normal ranges, 3 of them needed tracheostomy, and all of could be discharged from the hospital. Conclusion: Although, ECMO support for severe respiratory failure patients with COVID-19 is more challenging than regular ECMO applications, especially VV ECMO usage should be reminded as a remedy