Efficacy and Safety of Carbon Dioxide Versus Air Insufflation for Colonoscopy in Deeply Sedated Pediatric Patients

Authors

Rajmohan Dharmaraj, Division of Gastroenterology, University of New Mexico, Carrie Tingley Hospital, Albuquerque, NM
Rachel Dunn, Division of Department of Gastroenterology, Peyton Manning Children's Hospital, Indianapolis, IN
Julia Fritz, Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Maine Medical Center, Portland, ME
Mahua Dasgupta, Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
Pippa Simpson, Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
Jose Cabrera, Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
Adrian Miranda, Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
Diana G. Lerner, Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI

Document Type

Article

Publication Date

7-1-2020

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.

Publisher

Lippincott Williams & Wilkins

Publication Title

Journal of pediatric gastroenterology and nutrition

ISSN

1536-4801

Volume

71

Issue

1

First Page

34

Last Page

39

DOI

10.1097/MPG.0000000000002650

Recommended Citation

Dharmaraj R, Dunn R, Fritz J, Dasgupta M, Simpson P, Cabrera J, Miranda A, Lerner DG. Efficacy and Safety of Carbon Dioxide Versus Air Insufflation for Colonoscopy in Deeply Sedated Pediatric Patients. J Pediatr Gastroenterol Nutr. 2020 Jul;71(1):34-39. doi: 10.1097/MPG.0000000000002650. PMID: 32044831.