Adverse Sedation Events in Pediatrics: A Critical Incident Analysis of Contributing Factors

Abstract

This study-a critical incident analysis-identifies several features associated with adverse sedation events and poor outcome. There were differences in outcomes for venue: adverse outcomes (permanent neurologic injury or death) occurred more frequently in a nonhospital-based facility, whereas successful outcomes (prolonged hospitalization or no harm) occurred more frequently in a hospital-based setting. Inadequate resuscitation was more often associated with a nonhospital-based setting. Inadequate and inconsistent physiologic monitoring (particularly failure to use or respond appropriately to pulse oximetry) was another major factor contributing to poor outcome in all venues. Other issues rated by the reviewers were: inadequate presedation medical evaluation, lack of an independent observer, medication errors, and inadequate recovery procedures. Uniform, specialty-independent guidelines for monitoring children during and after sedation are essential. Age and size-appropriate equipment and medications for resuscitation should be immediately available regardless of the location where the child is sedated. All health care providers who sedate children, regardless of practice venue, should have advanced airway assessment and management training and be skilled in the resuscitation of infants and children so that they can successfully rescue their patient should an adverse sedation event occur.

Conscious Sedation of Children With Propofol Is Anything but Conscious

“…Regulatory bodies have little influence on the care that patients receive outside the hospital or ambulatory care setting. After an evaluation of the Food and Drug Administration adverse drug event reporting system, Cote et al 15 reported that permanent neurologic injury or death occurred more frequently in a non-hospital-based facility (92.8% vs 37.2%). This study and others have clearly demonstrated that conscious sedation may rapidly progress to deep sedation and even general anesthesia.…”

Aceptabilidad y eficacia del midazolam oral en jugo y en gelatina en la sedación consciente de pacientes pre-escolares para su atención estomatológica

“…Dichos datos están respaldados por estudios similares de sedación consciente para tratamiento estomatológico en niños a través de midazolam por vía oral (20,23), reconfi rmando la seguridad de la dosis utilizada por vía oral (25,26).…”

Sedation for Pediatric Endoscopies

“…Cote et al reported on the adverse sedation events in children in a study published in 2000 (Cote, Notterman et al 2000). This study was a critical incident analysis of contributory factors.…”