【Pediatric Anesthesia】Management of Pediatric Gastrointestinal Anesthesia

Pediatric gastroenteroscopy anesthesia Gastrointestinal endoscopy has become an indispensable means of pediatric gastroenterology examination, and plays an important role in the diagnosis and treatment of digestive tract diseases, while pediatric gastroenteroscopy anesthesia is anesthesia outside the operating room important part of
.

Young children are usually unable to cooperate with the examination.
General anesthesia or sedation provides convenience for these children to perform gastroenteroscopy examination, reduces the psychological burden of parents, and makes this examination method more widely used
.

The operation of gastroscope and gastroscopy is not very exciting, but the children do not cooperate in the examination.
In addition, the children's own physiological characteristics, such as small alimentary tract lumen, fast peristalsis, sensitive throat, and strong nausea and vomiting, are usually required.
Sedation or general anesthesia is administered
.

The fasting before gastroscopy is the same as the fasting requirements for elective surgery in the operating room, and the examination is performed on an empty stomach, otherwise there is food in the stomach that affects the observation and increases the risk of vomiting, reflux and aspiration after anesthesia
.

If the child has delayed gastric emptying or pyloric obstruction, the fasting time should be prolonged
.

If the barium meal examination has been done, the barium can adhere to the gastrointestinal mucosa, especially the ulcer site, which makes the diagnosis of fiberoptic gastroscope difficult.
Therefore, the gastroscopy must be done at least three days after the barium meal examination
.

Before the examination, ask the child whether there are loose teeth, in order to prevent the loose teeth from falling off and causing airway obstruction or even suffocation
.

The key to the inspection is the management of the airway.
The inspection time is long, the mirror is thick, and the airway is blocked by long-term inflation
.

Anesthesiologists have high requirements for airway pre-judgment in children.
If dyspnea or cyanosis occurs due to hypoventilation, it is necessary to immediately withdraw from the mirror while inhaling gas, and pressurize oxygen
.

In addition, try to avoid and timely deal with bronchospasm and laryngospasm caused by the operation
.

For children who are frail, have respiratory diseases, therapeutic operations under gastroscope or young children, general anesthesia (endotracheal intubation) should be selected to ensure the safety of children
.

In older children, gastroscopy can be performed under sedation
.

In addition, the operator's operation level should also be considered.
If the duration of the relatively rough examination is uncertain, the anesthesiologist's selection method should be adjusted accordingly
.

Colonoscopy is generally considered to be more stimulating than gastroscopic examination, and the stimulation is relatively greater when the endoscopy is inserted and the mirror passes through the spleen area.
On the basis of intravenous maintenance of propofol, low-dose opioids can be used to maintain anesthesia and sedation or choose general anesthesia.

.

Considering the inconsistency of pain stimuli during colonoscopy, general anesthesia is recommended in order to immobilize the patient for ease of examination
.

Since there is no surgical operation to interfere with airway patency, tracheal intubation is generally not required, and laryngeal mask assisted ventilation can be selected
.

Stimulation of the anorectal vagus nerve during colonoscopy, combined with fluid insufficiency caused by frequent artificial diarrhea during fasting and bowel preparation, and dose-related inhibition of circulation during propofol anesthesia may lead to lower blood pressure, so general anesthesia is not effective.
Painful colonoscopy should pay special attention to circulatory problems
.

Propofol has the ability to inhibit the activity of phosphodiesterase in smooth muscle cells, which can reduce gastrointestinal motility and facilitate the placement, observation and biopsy of colonoscopy
.

It has the characteristics of quick onset, comfortable sedation, easy control of sedation depth, and quick and complete awakening after drug withdrawal.
It has achieved good results in the application of painless gastrointestinal endoscopy
.

At the same time, propofol also has the disadvantages of too fast bolus injection, which is easy to produce bradycardia and low BP, transient respiratory depression, injection pain and other adverse reactions and weak analgesic effect
.

Therefore, in clinical work, we try to add different adjuvant drugs during propofol anesthesia, and use their synergistic effect to minimize the side effects of propofol and achieve better anesthesia effect
.

Fentanyl is a potent opioid analgesic, and the application of small doses has little effect on the respiratory and circulation.
Combined with propofol, it can enhance the analgesic effect and reduce the dosage of propofol
.

Midazolam has a short half-life, has obvious sedative and anterograde amnestic effects, and has little effect on breathing and circulation when used in small doses
.

Propofol combined with low-dose fentanyl is safe and effective for pediatric gastroscopy.
It can reduce the dosage of propofol, shorten the examination time, and wake up quickly from anesthesia without obvious adverse reactions
.

After the addition of midazolam, the induction dose and total dose of propofol decreased, but the wake-up time was prolonged, which was related to the sedative-hypnotic effect of midazolam
.

Postoperative monitoring, the risk of nausea and vomiting in children after examination increases, and the possibility of nausea and vomiting, reflux and aspiration should be avoided
.

After being completely awake, the complications of no operation and complications of anesthesia were observed, and the patient was transferred to the ward
.

   Reference books: Editor-in-Chief Zhang Jianmin, Selected Typical Cases of Pediatric Surgical Anesthesia, for Wen Wu Yajun END