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SEDATION AND ANALGESIA FOR REDUCTION OF PAEDIATRIC ILEOCOLIC INTUSSUSCEPTION: A MULTINATIONAL CROSS-SECTIONAL STUDY
- Naveen P. Poonai (Canada)
Abstract
Background and Aims
Ileocolic intussusception is an important cause of intestinal obstruction in children. Timely reduction of intussusception is standard of care. It is believed to be distressing but usually performed without sedation due to controversies surrounding increased risks of intestinal perforation and failed reduction. We sought to characterize practice patterns related to sedation and analgesia for reduction of ileocolic intussusception in children.
Methods
We conducted a medical record review of children 4-48 months who underwent attempted reduction of ileocolic intussusception from January 1, 2017, to December 31, 2019, in 86 institutions in 14 countries. The primary outcomes were sedation and analgesia within 120 minutes of the reduction. Bivariate and multivariable models explored the relationship with perforation and failed reduction.
Results
We included 3203 patients [2054/3203 (64·1%) males; median (IQR) age of 17 months (9,27)]. 346/3203 (10·8%), 466/3203 (14·5%), and 208/3203 (6.5%) patients received sedation, analgesia, or both, respectively. Perforation was uncommon (13/3165; 0·4%). In the bivariate analysis, perforation was not significantly associated with analgesia [OR:1·77;95%CI:0·48,6·44;p=0.389] or sedation [OR:0·69;95%CI:0·09,5·30;p=0.719]. In the adjusted analysis, perforation was not significantly associated with analgesia plus sedation [OR:1·25;95%CI:0·55,2·82;p=0·593] or number of reduction attempts [OR:0·95;95%CI:0·77,1·17;p=0·621]. Failed reduction occurred in 484/3184(15.2%) attempts and in the adjusted analysis, significantly associated with age [OR:1·05(per month increase);95%CI:1·03,1·06;p<0·001], time to reduction [OR:0·96(per hour increase);95%CI:0·94,0·99;p=0·002], analgesia plus sedation [OR:2·33;95%CI:1·43,3·80;p<0·001], and pre-existing gastrointestinal anomaly [OR:4·00;95%CI:1·37,11·73;p=0·011] but not analgesia alone [OR:1·33;95%CI:0·92,1·92;p=0·131] or type of reduction [OR:1·13(hydrostatic versus air);95%CI:0·79,1·61;p=0·513].
Conclusions
Findings of this large multinational cohort suggest that children may be safely administered sedation or analgesia for reduction of ileocolic intussusception.