Efficacy and Safety of Pediatric Procedural Sedation Outside the Operating Room

Abstract

Background: The volume of pediatric Procedural Sedation and Analgesia (PSA) outside the operating room has been increasing. This high clinical demand leads non-anesthesiologists, especially pediatric intensivists, pediatricians, and emergency physicians, to take a role in performing procedural sedation. Our department has established the PSA service by pediatric intensivists since 2015. Objectives: We aimed to assess the efficacy and safety of PSA outside the operating room conducted by pediatric intensivists and identify risk factors for severe adverse events. Methods: This was a retrospective descriptive study conducted from January 2015 to July 2019. Children aged less than 20 years who underwent procedural sedation were included. We collected demographic data, sedative and analgesic medications, American Society of Anesthesiologists (ASA) Physical Status Classification, indications for sedation, the success of procedural sedation, and any adverse events. Results: Altogether, 395 patients with 561 procedural sedation cases were included. The median age was 55 months (range: 15 to 119 months), and 58.5% (231/395) were male. The rate of successful procedures under PSA was 99.3%. Serious Adverse Events (SAE) occurred in 2.7%. Patients who received more than three sedative medications had higher SAE than patients who received fewer medications (adjusted for age, location of sedation, type of procedure, and ASA classification) (odds ratio: 8.043; 95% CI: 2.472 - 26.173, P = 0.001). Conclusions: Our data suggest that children who undergo procedural sedation outside the operating room conducted by pediatric intensivists are safe and effectively treated. Receiving more than three sedative medications is the independent risk factor associated with serious adverse events.

Lung Ultrasound Assisted Comparison of Volume Effects of Fluid Replacement Regimens in Pediatric Patients Undergoing Penile Hypospadias Repair: A Randomized Controlled Trial

“…LUS is a non-invasive diagnostic modality, which can reduce the perioperative complication rate (17). It is able to assess the condition of the lungs and its associated vasculature in a simple way.…”

Comparative Evaluation of Difficult Intubation Predictors in Children Under Two Years of Ages

“…Difficult airway management is one of the significant challenges in pediatric anesthesia (1)(2)(3). The difficult airway in children can quickly turn into a greatly serious situation that may lead to unfavorable and irreversible brain consequences that could even be life-threatening (2,4). Severe complications of the difficult airway include brain injury, cardiac arrest, and death (1,5,6) Pediatric patients have significant anatomical and physiological differences compared to adults, which affect the clinical judgment of the anesthesiologist to assess difficult airways (7,8).…”

“…Difficult airway management is one of the significant challenges in pediatric anesthesia ( 1 - 3 ). The difficult airway in children can quickly turn into a greatly serious situation that may lead to unfavorable and irreversible brain consequences that could even be life-threatening ( 2 , 4 ). Severe complications of the difficult airway include brain injury, cardiac arrest, and death ( 1 , 5 , 6 )…”

Effects of the Two Doses of Dexmedetomidine on Sedation, Agitation, and Bleeding During Pediatric Adenotonsillectomy

“…Controlled hypotension should be used with caution to minimize the risk of damage to vital organs. Important risks that may arise from using controlled hypotension include the possibility of coronary, cerebral, or renal circulatory failure ( 9 ).…”