Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception
Ileocolic intussusception is an important cause of intestinal obstruction in children. Reduction of ileocolic intussusception using air or fluid enema is the standard of care. This likely distressing procedure is usually performed without sedation or analgesia, but practice variation exists. To char...
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| Veröffentlicht in: | JAMA network open 2023-06, Vol.6 (6), p.e2317200-e2317200 |
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| creator | Poonai, Naveen Cohen, Daniel M MacDowell, Doug Mistry, Rakesh D Mintegi, Santiago Craig, Simon Roland, Damian Miller, Michael Shavit, Itai Wang, Yvette Nager, Alan Heyming, Theodore Burns, Rebekah Trehan, Indi Lipshaw, Matthew Sulton, Carmen Li, Joyce Ojo, Aderonke Kelly, Susan Thornton, Matthew Caperell, Kerry Amoni, Iluonose Abrams, Anna Duong, Myto Wassem, Muhammad Davis, Adrienne Gravel, Jocelyn Doyon Trottier, Evelyne Bar Am, Neta Thompson, Graham Sabhaney, Vikram Meckler, Garth Jain, Rini Ali, Samina Bressan, Silvia Zangardi, Tiziana Villa, Giovanna Giacalone, Martina Seiler, Michelle Sahyoun, Cyril Romano, Fabrizio Bognar, Zsolt Hajosi-Kalcakosz, Szofia Amir, Lisa Hachimi-Idrissi, Said Pucuka, Zanda Zviedre, Astra Zeltina, Emilija Phillips, Natalie Borland, Meredith O'Brien, Sharon Marchant, Jeanette Kochar, Amit George, Shane Pennington, Victoria Lyttle, Mark Browning, Jen McLoughlin, Anna Hartshorn, Stuart Urooj, Chaman Johnston, Lucy Walton, Emily Subrahmanyam Puthucode, Deepika Peacock, Phil Conroy, James Marañon, Rafael Garcia, Silvia Cahís, Nuria Cámara-Otegui, Amaia Gomez, Arantxa Carbonero, Maria Angelats-Romero, Carlos Yock-Corrales, Adriana Hualde, Gabriela Spigariol, Fabian Donas, Alex Gübeli Linné, Cinthia Rocchi, Alessia Pedrazzini, Alessia Cozzi, Giorgio Barbi, Dino Baggio, Laura La Fauci, Giovana Mauro, Angela Steimle, Matthew Buonsenso, Danilo Ugalde, Irma Nieva, Gaby Harper, Charlotte Sforzi, Idanna Jain, Shobhit |
| description | Ileocolic intussusception is an important cause of intestinal obstruction in children. Reduction of ileocolic intussusception using air or fluid enema is the standard of care. This likely distressing procedure is usually performed without sedation or analgesia, but practice variation exists.
To characterize the prevalence of opioid analgesia and sedation and assess their association with intestinal perforation and failed reduction.
This cross-sectional study reviewed medical records of children aged 4 to 48 months with attempted reduction of ileocolic intussusception at 86 pediatric tertiary care institutions in 14 countries from January 2017 to December 2019. Of 3555 eligible medical records, 352 were excluded, and 3203 medical records were eligible. Data were analyzed in August 2022.
Reduction of ileocolic intussusception.
The primary outcomes were opioid analgesia within 120 minutes of reduction based on the therapeutic window of IV morphine and sedation immediately before reduction of intussusception.
We included 3203 patients (median [IQR] age, 17 [9-27] months; 2054 of 3203 [64.1%] males). Opioid use was documented in 395 of 3134 patients (12.6%), sedation 334 of 3161 patients (10.6%), and opioids plus sedation in 178 of 3134 patients (5.7%). Perforation was uncommon and occurred in 13 of 3203 patients (0.4%). In the unadjusted analysis, opioids plus sedation (odds ratio [OR], 5.92; 95% CI, 1.28-27.42; P = .02) and a greater number of reduction attempts (OR, 1.48; 95% CI, 1.03-2.11; P = .03) were significantly associated with perforation. In the adjusted analysis, neither of these covariates remained significant. Reductions were successful in 2700 of 3184 attempts (84.8%). In the unadjusted analysis, younger age, no pain assessment at triage, opioids, longer duration of symptoms, hydrostatic enema, and gastrointestinal anomaly were significantly associated with failed reduction. In the adjusted analysis, only younger age (OR, 1.05 per month; 95% CI, 1.03-1.06 per month; P |
| doi_str_mv | 10.1001/jamanetworkopen.2023.17200 |
| format | Article |
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Reduction of ileocolic intussusception using air or fluid enema is the standard of care. This likely distressing procedure is usually performed without sedation or analgesia, but practice variation exists.
To characterize the prevalence of opioid analgesia and sedation and assess their association with intestinal perforation and failed reduction.
This cross-sectional study reviewed medical records of children aged 4 to 48 months with attempted reduction of ileocolic intussusception at 86 pediatric tertiary care institutions in 14 countries from January 2017 to December 2019. Of 3555 eligible medical records, 352 were excluded, and 3203 medical records were eligible. Data were analyzed in August 2022.
Reduction of ileocolic intussusception.
The primary outcomes were opioid analgesia within 120 minutes of reduction based on the therapeutic window of IV morphine and sedation immediately before reduction of intussusception.
We included 3203 patients (median [IQR] age, 17 [9-27] months; 2054 of 3203 [64.1%] males). Opioid use was documented in 395 of 3134 patients (12.6%), sedation 334 of 3161 patients (10.6%), and opioids plus sedation in 178 of 3134 patients (5.7%). Perforation was uncommon and occurred in 13 of 3203 patients (0.4%). In the unadjusted analysis, opioids plus sedation (odds ratio [OR], 5.92; 95% CI, 1.28-27.42; P = .02) and a greater number of reduction attempts (OR, 1.48; 95% CI, 1.03-2.11; P = .03) were significantly associated with perforation. In the adjusted analysis, neither of these covariates remained significant. Reductions were successful in 2700 of 3184 attempts (84.8%). In the unadjusted analysis, younger age, no pain assessment at triage, opioids, longer duration of symptoms, hydrostatic enema, and gastrointestinal anomaly were significantly associated with failed reduction. In the adjusted analysis, only younger age (OR, 1.05 per month; 95% CI, 1.03-1.06 per month; P < .001), shorter duration of symptoms (OR, 0.96 per hour; 95% CI, 0.94-0.99 per hour; P = .002), and gastrointestinal anomaly (OR, 6.50; 95% CI, 2.04-20.64; P = .002) remained significant.
This cross-sectional study of pediatric ileocolic intussusception found that more than two-thirds of patients received neither analgesia nor sedation. Neither was associated with intestinal perforation or failed reduction, challenging the widespread practice of withholding analgesia and sedation for reduction of ileocolic intussusception in children.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2023.17200</identifier><identifier>PMID: 37285152</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adolescent ; Analgesia - adverse effects ; Analgesics, Opioid - therapeutic use ; Anesthesia ; Child ; Cross-Sectional Studies ; Female ; Gastrointestinal diseases ; Humans ; Intestinal obstruction ; Intestinal Perforation - etiology ; Intussusception - complications ; Male ; Medical records ; Narcotics ; Online Only ; Original Investigation ; Pediatrics</subject><ispartof>JAMA network open, 2023-06, Vol.6 (6), p.e2317200-e2317200</ispartof><rights>2023. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2023 Poonai N et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a474t-12c72934e839296c4bff870efcfc77604146d3463050e1c04725d75f22af86803</citedby><cites>FETCH-LOGICAL-a474t-12c72934e839296c4bff870efcfc77604146d3463050e1c04725d75f22af86803</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,860,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37285152$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Poonai, Naveen</creatorcontrib><creatorcontrib>Cohen, Daniel M</creatorcontrib><creatorcontrib>MacDowell, Doug</creatorcontrib><creatorcontrib>Mistry, Rakesh D</creatorcontrib><creatorcontrib>Mintegi, Santiago</creatorcontrib><creatorcontrib>Craig, Simon</creatorcontrib><creatorcontrib>Roland, Damian</creatorcontrib><creatorcontrib>Miller, Michael</creatorcontrib><creatorcontrib>Shavit, Itai</creatorcontrib><creatorcontrib>Wang, Yvette</creatorcontrib><creatorcontrib>Nager, Alan</creatorcontrib><creatorcontrib>Heyming, Theodore</creatorcontrib><creatorcontrib>Burns, Rebekah</creatorcontrib><creatorcontrib>Trehan, Indi</creatorcontrib><creatorcontrib>Lipshaw, Matthew</creatorcontrib><creatorcontrib>Sulton, Carmen</creatorcontrib><creatorcontrib>Li, Joyce</creatorcontrib><creatorcontrib>Ojo, Aderonke</creatorcontrib><creatorcontrib>Kelly, Susan</creatorcontrib><creatorcontrib>Thornton, Matthew</creatorcontrib><creatorcontrib>Caperell, Kerry</creatorcontrib><creatorcontrib>Amoni, Iluonose</creatorcontrib><creatorcontrib>Abrams, Anna</creatorcontrib><creatorcontrib>Duong, Myto</creatorcontrib><creatorcontrib>Wassem, Muhammad</creatorcontrib><creatorcontrib>Davis, Adrienne</creatorcontrib><creatorcontrib>Gravel, Jocelyn</creatorcontrib><creatorcontrib>Doyon Trottier, Evelyne</creatorcontrib><creatorcontrib>Bar Am, Neta</creatorcontrib><creatorcontrib>Thompson, Graham</creatorcontrib><creatorcontrib>Sabhaney, Vikram</creatorcontrib><creatorcontrib>Meckler, Garth</creatorcontrib><creatorcontrib>Jain, Rini</creatorcontrib><creatorcontrib>Ali, Samina</creatorcontrib><creatorcontrib>Bressan, Silvia</creatorcontrib><creatorcontrib>Zangardi, Tiziana</creatorcontrib><creatorcontrib>Villa, Giovanna</creatorcontrib><creatorcontrib>Giacalone, Martina</creatorcontrib><creatorcontrib>Seiler, Michelle</creatorcontrib><creatorcontrib>Sahyoun, Cyril</creatorcontrib><creatorcontrib>Romano, Fabrizio</creatorcontrib><creatorcontrib>Bognar, Zsolt</creatorcontrib><creatorcontrib>Hajosi-Kalcakosz, Szofia</creatorcontrib><creatorcontrib>Amir, Lisa</creatorcontrib><creatorcontrib>Hachimi-Idrissi, Said</creatorcontrib><creatorcontrib>Pucuka, Zanda</creatorcontrib><creatorcontrib>Zviedre, Astra</creatorcontrib><creatorcontrib>Zeltina, Emilija</creatorcontrib><creatorcontrib>Phillips, Natalie</creatorcontrib><creatorcontrib>Borland, Meredith</creatorcontrib><creatorcontrib>O'Brien, Sharon</creatorcontrib><creatorcontrib>Marchant, Jeanette</creatorcontrib><creatorcontrib>Kochar, Amit</creatorcontrib><creatorcontrib>George, Shane</creatorcontrib><creatorcontrib>Pennington, Victoria</creatorcontrib><creatorcontrib>Lyttle, Mark</creatorcontrib><creatorcontrib>Browning, Jen</creatorcontrib><creatorcontrib>McLoughlin, Anna</creatorcontrib><creatorcontrib>Hartshorn, Stuart</creatorcontrib><creatorcontrib>Urooj, Chaman</creatorcontrib><creatorcontrib>Johnston, Lucy</creatorcontrib><creatorcontrib>Walton, Emily</creatorcontrib><creatorcontrib>Subrahmanyam Puthucode, Deepika</creatorcontrib><creatorcontrib>Peacock, Phil</creatorcontrib><creatorcontrib>Conroy, James</creatorcontrib><creatorcontrib>Marañon, Rafael</creatorcontrib><creatorcontrib>Garcia, Silvia</creatorcontrib><creatorcontrib>Cahís, Nuria</creatorcontrib><creatorcontrib>Cámara-Otegui, Amaia</creatorcontrib><creatorcontrib>Gomez, Arantxa</creatorcontrib><creatorcontrib>Carbonero, Maria</creatorcontrib><creatorcontrib>Angelats-Romero, Carlos</creatorcontrib><creatorcontrib>Yock-Corrales, Adriana</creatorcontrib><creatorcontrib>Hualde, Gabriela</creatorcontrib><creatorcontrib>Spigariol, Fabian</creatorcontrib><creatorcontrib>Donas, Alex</creatorcontrib><creatorcontrib>Gübeli Linné, Cinthia</creatorcontrib><creatorcontrib>Rocchi, Alessia</creatorcontrib><creatorcontrib>Pedrazzini, Alessia</creatorcontrib><creatorcontrib>Cozzi, Giorgio</creatorcontrib><creatorcontrib>Barbi, Dino</creatorcontrib><creatorcontrib>Baggio, Laura</creatorcontrib><creatorcontrib>La Fauci, Giovana</creatorcontrib><creatorcontrib>Mauro, Angela</creatorcontrib><creatorcontrib>Steimle, Matthew</creatorcontrib><creatorcontrib>Buonsenso, Danilo</creatorcontrib><creatorcontrib>Ugalde, Irma</creatorcontrib><creatorcontrib>Nieva, Gaby</creatorcontrib><creatorcontrib>Harper, Charlotte</creatorcontrib><creatorcontrib>Sforzi, Idanna</creatorcontrib><creatorcontrib>Jain, Shobhit</creatorcontrib><creatorcontrib>Paediatric Emergency Research Networks (PERN) PAINT Study Group</creatorcontrib><title>Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>Ileocolic intussusception is an important cause of intestinal obstruction in children. Reduction of ileocolic intussusception using air or fluid enema is the standard of care. This likely distressing procedure is usually performed without sedation or analgesia, but practice variation exists.
To characterize the prevalence of opioid analgesia and sedation and assess their association with intestinal perforation and failed reduction.
This cross-sectional study reviewed medical records of children aged 4 to 48 months with attempted reduction of ileocolic intussusception at 86 pediatric tertiary care institutions in 14 countries from January 2017 to December 2019. Of 3555 eligible medical records, 352 were excluded, and 3203 medical records were eligible. Data were analyzed in August 2022.
Reduction of ileocolic intussusception.
The primary outcomes were opioid analgesia within 120 minutes of reduction based on the therapeutic window of IV morphine and sedation immediately before reduction of intussusception.
We included 3203 patients (median [IQR] age, 17 [9-27] months; 2054 of 3203 [64.1%] males). Opioid use was documented in 395 of 3134 patients (12.6%), sedation 334 of 3161 patients (10.6%), and opioids plus sedation in 178 of 3134 patients (5.7%). Perforation was uncommon and occurred in 13 of 3203 patients (0.4%). In the unadjusted analysis, opioids plus sedation (odds ratio [OR], 5.92; 95% CI, 1.28-27.42; P = .02) and a greater number of reduction attempts (OR, 1.48; 95% CI, 1.03-2.11; P = .03) were significantly associated with perforation. In the adjusted analysis, neither of these covariates remained significant. Reductions were successful in 2700 of 3184 attempts (84.8%). In the unadjusted analysis, younger age, no pain assessment at triage, opioids, longer duration of symptoms, hydrostatic enema, and gastrointestinal anomaly were significantly associated with failed reduction. In the adjusted analysis, only younger age (OR, 1.05 per month; 95% CI, 1.03-1.06 per month; P < .001), shorter duration of symptoms (OR, 0.96 per hour; 95% CI, 0.94-0.99 per hour; P = .002), and gastrointestinal anomaly (OR, 6.50; 95% CI, 2.04-20.64; P = .002) remained significant.
This cross-sectional study of pediatric ileocolic intussusception found that more than two-thirds of patients received neither analgesia nor sedation. Neither was associated with intestinal perforation or failed reduction, challenging the widespread practice of withholding analgesia and sedation for reduction of ileocolic intussusception in children.</description><subject>Adolescent</subject><subject>Analgesia - adverse effects</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Anesthesia</subject><subject>Child</subject><subject>Cross-Sectional Studies</subject><subject>Female</subject><subject>Gastrointestinal diseases</subject><subject>Humans</subject><subject>Intestinal obstruction</subject><subject>Intestinal Perforation - etiology</subject><subject>Intussusception - complications</subject><subject>Male</subject><subject>Medical records</subject><subject>Narcotics</subject><subject>Online Only</subject><subject>Original 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Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20230601</creationdate><title>Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception</title><author>Poonai, Naveen ; Cohen, Daniel M ; MacDowell, Doug ; Mistry, Rakesh D ; Mintegi, Santiago ; Craig, Simon ; Roland, Damian ; Miller, Michael ; Shavit, Itai ; Wang, Yvette ; Nager, Alan ; Heyming, Theodore ; Burns, Rebekah ; Trehan, Indi ; Lipshaw, Matthew ; Sulton, Carmen ; Li, Joyce ; Ojo, Aderonke ; Kelly, Susan ; Thornton, Matthew ; Caperell, Kerry ; Amoni, Iluonose ; Abrams, Anna ; Duong, Myto ; Wassem, Muhammad ; Davis, Adrienne ; Gravel, Jocelyn ; Doyon Trottier, Evelyne ; Bar Am, Neta ; Thompson, Graham ; Sabhaney, Vikram ; Meckler, Garth ; Jain, Rini ; Ali, Samina ; Bressan, Silvia ; Zangardi, Tiziana ; Villa, Giovanna ; Giacalone, Martina ; Seiler, Michelle ; Sahyoun, Cyril ; Romano, Fabrizio ; Bognar, Zsolt ; Hajosi-Kalcakosz, Szofia ; Amir, Lisa ; Hachimi-Idrissi, Said ; Pucuka, Zanda ; Zviedre, Astra ; Zeltina, Emilija ; Phillips, Natalie ; Borland, Meredith ; O'Brien, Sharon ; Marchant, Jeanette ; Kochar, Amit ; George, Shane ; Pennington, Victoria ; Lyttle, Mark ; Browning, Jen ; McLoughlin, Anna ; Hartshorn, Stuart ; Urooj, Chaman ; Johnston, Lucy ; Walton, Emily ; Subrahmanyam Puthucode, Deepika ; Peacock, Phil ; Conroy, James ; Marañon, Rafael ; Garcia, Silvia ; Cahís, Nuria ; Cámara-Otegui, Amaia ; Gomez, Arantxa ; Carbonero, Maria ; Angelats-Romero, Carlos ; Yock-Corrales, Adriana ; Hualde, Gabriela ; Spigariol, Fabian ; Donas, Alex ; Gübeli Linné, Cinthia ; Rocchi, Alessia ; Pedrazzini, Alessia ; Cozzi, Giorgio ; Barbi, Dino ; Baggio, Laura ; La Fauci, Giovana ; Mauro, Angela ; Steimle, Matthew ; Buonsenso, Danilo ; Ugalde, Irma ; Nieva, Gaby ; Harper, Charlotte ; Sforzi, Idanna ; Jain, Shobhit</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a474t-12c72934e839296c4bff870efcfc77604146d3463050e1c04725d75f22af86803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adolescent</topic><topic>Analgesia - adverse effects</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Anesthesia</topic><topic>Child</topic><topic>Cross-Sectional Studies</topic><topic>Female</topic><topic>Gastrointestinal diseases</topic><topic>Humans</topic><topic>Intestinal obstruction</topic><topic>Intestinal Perforation - etiology</topic><topic>Intussusception - complications</topic><topic>Male</topic><topic>Medical records</topic><topic>Narcotics</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Pediatrics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Poonai, Naveen</creatorcontrib><creatorcontrib>Cohen, Daniel M</creatorcontrib><creatorcontrib>MacDowell, Doug</creatorcontrib><creatorcontrib>Mistry, Rakesh D</creatorcontrib><creatorcontrib>Mintegi, Santiago</creatorcontrib><creatorcontrib>Craig, Simon</creatorcontrib><creatorcontrib>Roland, Damian</creatorcontrib><creatorcontrib>Miller, Michael</creatorcontrib><creatorcontrib>Shavit, Itai</creatorcontrib><creatorcontrib>Wang, Yvette</creatorcontrib><creatorcontrib>Nager, Alan</creatorcontrib><creatorcontrib>Heyming, Theodore</creatorcontrib><creatorcontrib>Burns, Rebekah</creatorcontrib><creatorcontrib>Trehan, 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(Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Poonai, Naveen</au><au>Cohen, Daniel M</au><au>MacDowell, Doug</au><au>Mistry, Rakesh D</au><au>Mintegi, Santiago</au><au>Craig, Simon</au><au>Roland, Damian</au><au>Miller, Michael</au><au>Shavit, Itai</au><au>Wang, Yvette</au><au>Nager, Alan</au><au>Heyming, Theodore</au><au>Burns, Rebekah</au><au>Trehan, Indi</au><au>Lipshaw, Matthew</au><au>Sulton, Carmen</au><au>Li, Joyce</au><au>Ojo, Aderonke</au><au>Kelly, Susan</au><au>Thornton, Matthew</au><au>Caperell, Kerry</au><au>Amoni, Iluonose</au><au>Abrams, Anna</au><au>Duong, Myto</au><au>Wassem, Muhammad</au><au>Davis, Adrienne</au><au>Gravel, Jocelyn</au><au>Doyon Trottier, Evelyne</au><au>Bar Am, Neta</au><au>Thompson, Graham</au><au>Sabhaney, Vikram</au><au>Meckler, Garth</au><au>Jain, Rini</au><au>Ali, Samina</au><au>Bressan, Silvia</au><au>Zangardi, Tiziana</au><au>Villa, Giovanna</au><au>Giacalone, Martina</au><au>Seiler, Michelle</au><au>Sahyoun, Cyril</au><au>Romano, Fabrizio</au><au>Bognar, Zsolt</au><au>Hajosi-Kalcakosz, Szofia</au><au>Amir, Lisa</au><au>Hachimi-Idrissi, Said</au><au>Pucuka, Zanda</au><au>Zviedre, Astra</au><au>Zeltina, Emilija</au><au>Phillips, Natalie</au><au>Borland, Meredith</au><au>O'Brien, Sharon</au><au>Marchant, Jeanette</au><au>Kochar, Amit</au><au>George, Shane</au><au>Pennington, Victoria</au><au>Lyttle, Mark</au><au>Browning, Jen</au><au>McLoughlin, Anna</au><au>Hartshorn, Stuart</au><au>Urooj, Chaman</au><au>Johnston, Lucy</au><au>Walton, Emily</au><au>Subrahmanyam Puthucode, Deepika</au><au>Peacock, Phil</au><au>Conroy, James</au><au>Marañon, Rafael</au><au>Garcia, Silvia</au><au>Cahís, Nuria</au><au>Cámara-Otegui, Amaia</au><au>Gomez, Arantxa</au><au>Carbonero, Maria</au><au>Angelats-Romero, Carlos</au><au>Yock-Corrales, Adriana</au><au>Hualde, Gabriela</au><au>Spigariol, Fabian</au><au>Donas, Alex</au><au>Gübeli Linné, Cinthia</au><au>Rocchi, Alessia</au><au>Pedrazzini, Alessia</au><au>Cozzi, Giorgio</au><au>Barbi, Dino</au><au>Baggio, Laura</au><au>La Fauci, Giovana</au><au>Mauro, Angela</au><au>Steimle, Matthew</au><au>Buonsenso, Danilo</au><au>Ugalde, Irma</au><au>Nieva, Gaby</au><au>Harper, Charlotte</au><au>Sforzi, Idanna</au><au>Jain, Shobhit</au><aucorp>Paediatric Emergency Research Networks (PERN) PAINT Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2023-06-01</date><risdate>2023</risdate><volume>6</volume><issue>6</issue><spage>e2317200</spage><epage>e2317200</epage><pages>e2317200-e2317200</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>Ileocolic intussusception is an important cause of intestinal obstruction in children. Reduction of ileocolic intussusception using air or fluid enema is the standard of care. This likely distressing procedure is usually performed without sedation or analgesia, but practice variation exists.
To characterize the prevalence of opioid analgesia and sedation and assess their association with intestinal perforation and failed reduction.
This cross-sectional study reviewed medical records of children aged 4 to 48 months with attempted reduction of ileocolic intussusception at 86 pediatric tertiary care institutions in 14 countries from January 2017 to December 2019. Of 3555 eligible medical records, 352 were excluded, and 3203 medical records were eligible. Data were analyzed in August 2022.
Reduction of ileocolic intussusception.
The primary outcomes were opioid analgesia within 120 minutes of reduction based on the therapeutic window of IV morphine and sedation immediately before reduction of intussusception.
We included 3203 patients (median [IQR] age, 17 [9-27] months; 2054 of 3203 [64.1%] males). Opioid use was documented in 395 of 3134 patients (12.6%), sedation 334 of 3161 patients (10.6%), and opioids plus sedation in 178 of 3134 patients (5.7%). Perforation was uncommon and occurred in 13 of 3203 patients (0.4%). In the unadjusted analysis, opioids plus sedation (odds ratio [OR], 5.92; 95% CI, 1.28-27.42; P = .02) and a greater number of reduction attempts (OR, 1.48; 95% CI, 1.03-2.11; P = .03) were significantly associated with perforation. In the adjusted analysis, neither of these covariates remained significant. Reductions were successful in 2700 of 3184 attempts (84.8%). In the unadjusted analysis, younger age, no pain assessment at triage, opioids, longer duration of symptoms, hydrostatic enema, and gastrointestinal anomaly were significantly associated with failed reduction. In the adjusted analysis, only younger age (OR, 1.05 per month; 95% CI, 1.03-1.06 per month; P < .001), shorter duration of symptoms (OR, 0.96 per hour; 95% CI, 0.94-0.99 per hour; P = .002), and gastrointestinal anomaly (OR, 6.50; 95% CI, 2.04-20.64; P = .002) remained significant.
This cross-sectional study of pediatric ileocolic intussusception found that more than two-thirds of patients received neither analgesia nor sedation. Neither was associated with intestinal perforation or failed reduction, challenging the widespread practice of withholding analgesia and sedation for reduction of ileocolic intussusception in children.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>37285152</pmid><doi>10.1001/jamanetworkopen.2023.17200</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2574-3805 |
| ispartof | JAMA network open, 2023-06, Vol.6 (6), p.e2317200-e2317200 |
| issn | 2574-3805 2574-3805 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10248743 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adolescent Analgesia - adverse effects Analgesics, Opioid - therapeutic use Anesthesia Child Cross-Sectional Studies Female Gastrointestinal diseases Humans Intestinal obstruction Intestinal Perforation - etiology Intussusception - complications Male Medical records Narcotics Online Only Original Investigation Pediatrics |
| title | Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception |
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