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Time from sedation to discharge in a pediatric endoscopy unit is similar for drugs administered by an anesthesiologist or an endoscopist

The length of time from administration of anesthesia to hospital discharge is one measure of the efficiency of pediatric endoscopy units. Many pediatric endoscopists (specialists in the use of endoscopes for surgical and other procedures) are adopting the medication propofol, with the expectation that it will increase their overall efficiency. Yet a new study found that children given faster acting propofol by an anesthesiologist before being taken to the operating room did not leave the hospital sooner than patients administered the two-drug combination of midazolam and fentanyl by the endoscopist at the beginning of the procedure.

The patients at a large academic medical center received either type of anesthesia according to the preference of their gastroenterologist, noted Jenifer R. Lightdale, M.D., M.P.H. Her team prospectively tracked 134 children at a pediatric teaching hospital who underwent an endoscopic procedure. They looked at time to onset of sedation, procedure time, discharge time, and total time. Both groups had similar demographics, but overall time differences between the two groups balanced out.

Dr. Lightdale's team found that, while patients given propofol had slightly shorter median times for anesthesia onset (by 2-4 minutes) than those given midazolam and fentanyl, they also had longer procedure times and longer times to discharge. Overall, the time from initiation of anesthesia to release from the hospital were comparable, although patients given propofol were shown by earlier researchers to be faster in opening their eyes, responding to verbal commands, and orienting themselves. Times to sitting up, standing, and discharge were similar for both anesthesia groups.

The study was funded in part by the Agency for Healthcare Research and Quality (HS13675). More details are in "Efficiency of propofol versus midazolam and fentanyl sedation at a pediatric teaching hospital: A prospective study," by Dr. Lightdale, Clarissa Valim, M.D., Sc.D., Adrienne R. Newburg A.B., and others, in the July 2008 Gastrointestinal Endoscopy 67(7), pp. 1067-1075.

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