Our pediatric radiologist pointed me to work by Dr. Shiels, chief of
Radiology at Nationwide Children's Columbus. Dr. Shiels was instrumental
in introducing the air enema to the US. As opposed to contrast enemas,
which are an open pressure system, air enemas are a closed system.
Apparently, valsalva during crying produces brief spikes in intraluminal
pressure which are felt to help with the last difficult part of at least
some reductions. Valsalva also may decrease transmural pressure
differential. Hence the preference for no sedation. I found these
references on his professional webpage at:
Bramson, R, T; Shiels, W E 2nd; Eskey, C, J; Hu, S Y. 1997. Intraluminal
colon pressure dynamics with Valsalva maneuver during air enema study.
Radiology. Vol. 202, no. 3. (January): 825-828.
Shiels, W E 2nd. 1995. Intracolonic pressure and enemas in children:
form follows function. Radiology. Vol. 196, no. 1. (January): 19-21.
Shiels, W, E, II; Maves, C, K; Hedlund, G, L; Kirks, D, R. 1993. Air
enema for diagnosis and reduction of intussusception: Clinical
experience and pressure correlates. Year Book of Diagnostic Radiology.
Shiels, W E 2nd; Kirks, D, R; Keller, G, L; Ryckman, F, R; Daugherty, C,
C; Specker, B, L; Summa, D W. 1993. John Caffey Award. Colonic
perforation by air and liquid enemas: comparison study in young pigs.
AJR. American journal of roentgenology. Vol. 160, no. 5. (January):
On Mon, May 12, 2014, at 12:02 PM, Giora Weiser wrote:
> I am trying to find out what is the common practice in the big world...
> Here in Israel, when a child is diagnosed with an intussusception he will
> go to the radiology department for an air enema. There is a wide range of
> opinions whether sedation should be given for this procedure. The latest
> article that actually comes from Israel showed success with sedation.
> I was wondering what is accepted in the bigger medical centers? Is
> sedation used? Is it given by the EM people? A sedation service?
> Anyone know of good literature on the subject...?
> Thanks for the info,
> Giora Weiser
> Shaare Zedek Medical Center
> Jerusalem, Israel
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
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