Insufflation vs intubation during esophagogastroduodenoscopy in children.

OBJECTIVES: We compared adverse airway events during esophagogastroduodenoscopy (EGD) in children managed with insufflation vs intubation. BACKGROUND: Optimum airway management during EGD in children remains undecided. METHODS/MATERIALS: Following IRB approval and written informed parental consent, children between 1 and 12 years of age presenting for EGD were randomized to airway management with insufflation (Group I), intubation/awake extubation (Group A), or intubation/deep extubation (Group D). All subjects received a standardized anesthetic with sevoflurane in oxygen. Using uniform definitions, airway adverse events during and after EGD recovery were recorded. Categorical data were analysed with Chi-square contingency tables or Fisher's exact test as appropriate. RESULTS: Analyzable data were available for 415 subjects (Group I: 209; Group A: 101; Group D: 105). Desaturation, laryngospasm, any airway adverse event, and multiple airway adverse events during EGD were significantly more common in subjects in Group I compared to those in Groups A and D. Complaints of sore throat, hoarseness, stridor, and/or dysphagia were more common in subjects in Groups A and D. Analysis of confounders suggested that younger age, obesity, and midazolam premedication were independent predictors of airway adverse events during EGD. CONCLUSIONS: Insufflation during EGD was associated with a higher incidence of airway adverse events, including desaturation and laryngospasm; intubation during EGD was associated with more frequent complaints related to sore throat. As our results show that insufflation during EGD offers no advantage in terms of operational efficiency and is associated with more airway adverse events, we recommend endotracheal intubation during EGD, especially in patients who are younger, obese, or have received midazolam premedication.

Spinal deformity associated with carbohydrate-deficient glycoprotein syndrome (Jaeken's syndrome): a report of three cases.

STUDY DESIGN: Case reports are presented. OBJECTIVE: To report the association between carbohydrate-deficient glycoprotein syndrome Type 1a (CDGS Type 1a) and spinal deformity. SUMMARY OF BACKGROUND DATA: Carbohydrate-deficient glycoprotein syndrome Type 1a is an autosomal recessive metabolic disorder that may occur in association with spinal deformity. METHODS: Analyses of three cases are presented, including a review of the natural history of the disease. RESULTS: Three cases were reviewed in which spinal deformities developed in patients with CDGS Type 1a. Two patients required surgical correction of their spinal deformity, and one patient, at this writing, is undergoing conservative treatment. Before surgery, the pediatric hematology service was consulted regarding the patients' CDGD-related hypercoagulability. Of the two patients who underwent surgical correction, one had severe blood loss (7500 mL), and both cases were treated for infection via intravenous antibiotics. CONCLUSIONS: The incidence of CDGS Type 1a is 1 in 80,0000. Spinal deformity appears to be common in patients with CDGS Type 1a. Therefore, young patients with spinal deformities in combination with mental retardation, failure to thrive, abnormal fat distribution, and other symptoms of CDGS Type 1a should be assessed for this disorder, and patients with CDGS Type 1a should be screened also for spinal deformities. If abnormalities are identified early, treatment outcomes may be optimized.