Efficacy and Safety of Carbon Dioxide Versus Air Insufflation for Colonoscopy in Deeply Sedated Pediatric Patients. Issue 1 (July 2020)

• Record Type: Journal Article
• Authors: Dharmaraj, Rajmohan; Dunn, Rachel; Fritz, Julia; Dasgupta, Mahua; Simpson, Pippa; Cabrera, Jose; Miranda, Adrian; Lerner, Diana G.
• Is Part Of: Journal of pediatric gastroenterology and nutrition. Volume 71:Issue 1(2020)
• Publication Date: 2020-07
• Subjects: abdominal pain -- children -- carbon dioxide insufflation -- colonoscopy -- endoscopy -- pediatric; Children -- Nutrition -- Periodicals; Pediatric gastroenterology -- Periodicals; Infants -- Nutrition -- Periodicals; Nutrition disorders in children -- Periodicals; Child Nutrition -- Periodicals; Digestive System -- growth & development -- Periodicals; Gastrointestinal Diseases -- Periodicals; Infant Nutrition -- Periodicals; Nutrition Disorders -- Periodicals; Child; 618.923
• DOI: 10.1097/MPG.0000000000002650
• Languages: English
• ISSNs: 0277-2116

Abstract

ABSTRACT: Objectives: Studies have shown the advantages of carbon dioxide (CO2 ) over air insufflation in the adult population during colonoscopies. This study was designed to investigate the efficacy and safety of CO2 insufflation in deeply sedated children undergoing colonoscopy. Methods: This was a prospective, randomized, double-blind clinical trial. We recruited 100 consecutive pediatric patients who had colonoscopy under deep sedation for various indications. Patients were first randomized by history of abdominal pain and then randomly assigned to either CO2 or air insufflation. Postprocedural abdominal pain scores were registered on a 10-point visual analog rating scale and significant pain was defined as a score of 3 or higher. Abdominal circumferences and end tidal CO2 (ETCO2 ) levels were measured. Complications during and after the procedure were recorded. Results: We did not find statistically significant difference between CO2 and air insufflation on univariate analysis because of low number of children experiencing significant pain after colonoscopy. After adjusting for baseline pain, we found that pain was significantly lower in patients after CO2 versus air insufflation on multivariable analysis ( P = 0.03). The significant factors related to pain were duration of the procedure ( P = 0.006), history of abdominal pain ( P = 0.002) and previous abdominal surgery ( P = 0.02). CO2 insufflation was associated with decreased abdominal circumference after colonoscopy ( P = 0.002). Girls were more likely to have pain regardless of intervention ( P = .04). Conclusions: Most children tolerate endoscopic procedures without significant pain. Our study was underpowered to show significant difference between air and CO2 on univariate analysis. CO2 insufflation during colonoscopy, however, may reduce postprocedural abdominal pain. Significant factors for increased pain on multivariate analysis included colonoscopy length over 30 minutes, history of abdominal pain, and previous abdominal surgery. Abstract : Supplemental Digital Content is available in the text