Paediatric endoscopy should be carried out under general anaesthesia

BMJ 1995;311:452-453 (12 August)

Letters

Paediatric endoscopy should be carried out under general anaesthesia

EDITOR,--J E Charlton highlights the hazards of gastrointestinalendoscopy carried out under sedation.¹ These dangers are notconfined to adults.

In a prospective study of 32 children undergoing gastrointestinalendoscopy under sedation, desaturation (oxygen saturation of90% or less) occurred in 37.5%; this desaturation was unpredictableand failed to correlate with the patient's weight, age, or toleranceof the procedure.² In another prospective analysis, of 57 smallchildren, 10% of the examinations had to be interrupted by removalof the endoscope because the child developed stridor and a lowoxygen saturation.³ Despite these findings and the well documenteddata on adults, pulse oximetry and cardiac monitoring have notbeen universally used in children undergoing endoscopy undersedation.⁴ Clearly, if paediatric endoscopy is performed inthis way similar recommendations concerning careful monitoringand supplemental oxygen must apply.