Comparing Anesthetic Techniques in Children Having Esophagogastroduodenoscopies
Condition: Eosinophilic Esophagitis
MeSH terms: Esophagitis; Eosinophilic Esophagitis
Study type: Interventional

Summary: 
      The purpose of this research study is to compare the safety and effectiveness of three
      commonly used techniques for delivering anesthesia during a procedure known as
      esophagogastroduodenoscopy.
    

Detailed description: 
      Different anesthetic techniques are currently in use at Cincinnati Children's Hospital
      Medical Center (CCHMC) for delivering anesthesia during an esophagogastroduodenoscopy (EGD).
      Because there is a lack of evidence to delineate the best techniques, pediatric
      anesthesiologists select the technique based on clinical preference and experience. One
      anesthetic technique involves the use of general anesthesia with the placement of an
      endotracheal tube, and maintenance with an inhalation agent, such as sevoflurane (IS). These
      patients may be extubated under deep anesthesia in the operating room, and allowed to awaken
      in the post anesthesia care unit. A similar technique involves the placement of an
      endotracheal tube, and anesthetic maintenance with a continuous infusion of propofol (IP).
      These patients are also extubated under deep anesthesia in the operating room, and allowed to
      awaken in the postoperative care unit. The third technique does not use an endotracheal tube
      and anesthetic maintenance occurs with continuous infusion of propofol with the patient
      breathing oxygen through their natural airway (NA). Our objective in this study is to compare
      outcomes between these three established anesthetic techniques.

      Children in the study will be recruited from Cincinnati Children's Hospital Medical Center
      Operating Room Schedule. They will be cared for in the Operating Rooms and Post Anesthesia
      Care Unit.
    

Intervention name(s): Intubated with Sevoflurane (IS); Intubated with Propofol (IP); Zofran - no intubation; Propofol
Intervention type(s): Drug; Drug; Drug; Drug
Intervention description(s): Anesthesia will be maintained with sevoflurane 3% in oxygen at 2 L/min. The endoscopist will begin the procedure. The sevoflurane inspired concentration will be adjusted between 1 to 2 times the minimum alveolar concentration (MAC) by the attending anesthesiologist to maintain an appropriate level of anesthesia.; Anesthetic maintenance will be with 2 L/min flow of oxygen through the endotracheal tube and a continuous propofol infusion at a rate of 250 mcg/kg/min. A maximum of two bolus doses of propofol 0.5 to 1 mg/kg and an increase in the continuous infusion to 300 mcg/kg/min may be given at the discretion of the anesthetist if necessary to provide adequate anesthesia.; A nasal cannula will be placed with oxygen administered at a rate of 3 L/min, and a bite block will be inserted. Zofran will be administered. Anesthesia will be maintained with a continuous propofol infusion at a rate of 250 mcg/kg/min. A maximum of two bolus doses of propofol 0.5 to 1 mg/kg, and an increase of the continuous infusion to 300 mcg/kg/min may be given at the discretion of the anesthetist.
Intervention MeSH terms: Propofol; Sevoflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Anesthetic; Pediatric; Esophagogastroduodenoscopies; Eosinophilic esophagitis; Gastroesophageal reflux disease (GERD); Abdominal Pain; Vomiting; Sevofluorane; Propofol; Nasal cannula; Intubation; Endotracheal tube