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Reduction of ileocolic intussusception under sedation or anaesthesia: a systematic review of complications
  1. Moran Gal1,
  2. Shirly Gamsu2,
  3. Ron Jacob3,
  4. Daniel M Cohen4,
  5. Itai Shavit5
  1. 1Kaplan Medical Centre, Rehovot, Israel
  2. 2Shamir Medical Center, Beer Yaakov, Israel
  3. 3Haemek Medical Cente, Afula, Israel
  4. 4Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
  5. 5Rambam Health Care Campus, Haifa, Israel
  1. Correspondence to Prof Itai Shavit, Rambam Health Care Campus, Haifa 31096, Israel; itai{at}pem-database.org

Abstract

Background Despite the increased use of sedation in children undergoing stressful procedures, reduction of ileocolic intussusception (RII) is usually performed on awake children without any form of sedation.

Objective To evaluate the incidence of severe complications of RII under sedation or anaesthesia.

Design A systematic review including English language original articles of any date.

Patients Children undergoing RII (pneumatic or hydrostatic) under sedation or anaesthesia.

Data sources Ovid Embase, Scopus, PubMed, the Cochrane Database of Systematic Reviews and the internet search engine Google Scholar.

Data extraction Three authors independently reviewed each article for eligibility. The Newcastle-Ottawa Scale was used to assess the quality of included studies.

Main outcome measures The primary outcome was the incidence of intestinal perforation during RII. The secondary outcomes were the incidence of sentinel adverse events defined as death, cardiopulmonary resuscitation, permanent neurological deficit and pulmonary aspiration syndrome.

Results The search yielded 368 articles. Nine studies with 1391 cases were included in the analysis. Of the nine studies, six had a score of ≤6 stars in the Newcastle-Ottawa Scale assessment, indicating low-to-moderate quality. Propofol-based sedation was used in 849 (59.2%) cases; 5 (0.6%) had intestinal perforation. Intestinal perforation was not reported in patients who were sedated with other sedatives. One patient had pulmonary aspiration syndrome.

Conclusions Although caution remains warranted, current data suggest that the incidence of severe complications due to RII under sedation or anaesthesia is low. Due to the lack of prospective data, it is difficult to ascertain the exact incidence of severe complications.

  • emergency care
  • paediatric emergency medicine
  • pain

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors MG designed the study, analysed and interpreted the data, reviewed the literature and critically revised the article; SGS analysed and interpreted the data, reviewed the literature and critically revised the article; RJ analysed and interpreted the data, reviewed the literature and critically revised the article. DMC interpreted the data, reviewed the literature and critically revised the article. IS conceived the idea for the study, analysed and interpreted the data and drafted the manuscript. MG and IS have full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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