Pediatric Procedural Sedation in the Emergency Setting

Abstract

Background: Pediatric emergency department (ED) visits are common. Many are due to injury, which require procedural treatments with sedation. There are many well researched independent predictors of adverse events for pediatric procedural sedation. The duration of sedation as a predictor of adverse events has not been well studied. This study aims to determine the complication rate and severity of procedural sedation as well as determine if the duration of sedation is correlated with an increased risk of complications. Methods: After Institutional Review Board approval, a retrospective study was performed on all patients seen at Helen Devos Children’s ED who received sedation from August 1, 2011, to August 15, 2016. Study variables included age, weight, type of procedure, American Society of Anesthesiologist (ASA) physical status class, Mallampati score, comorbidities, sedation medication, sedation time, and complication. A logistic regression was performed assessing risk factors for complications. Statistical significance was assessed at P < 0.05. Results: There were 1,814 patients included in the study. Median sedation time was 20 minutes. There were 70 (3.9%) total complications. Controlling for age, weight, comorbidities, ASA class, Mallampati score, and total sedation medication, sedation time was a significant predictor of a complication (odds ratio: 1.021; 95% CI, 1.004–1.039). Conclusions: Pediatric patients can safely undergo procedural sedation in the ED. This study demonstrates a high safety profile for long procedural sedations with slight increases in risk as sedation time increases. There is no identifiable time where the duration of sedation significantly increases the risk of complication.

Management of Dog Bite Injuries

“…This range of sedation of length did not increase any associated risks, further supporting existing literature on pediatric procedural sedation. In a study conducted by Lucich et al, 12 1814 cases of pediatric procedural sedation were reviewed. The most frequent procedures performed requiring sedation were fracture reduction (60.9%), followed by laceration repair (20.4%).…”

“…Ketamine was the most used method of sedation (1251 patients), followed by propofol (404 patients). Most significantly, this article suggested there is no increased risk to longer sedation times 12 . Thus, the use of procedural sedation can offset the burden placed on operating theaters by reducing the amount of distress and agitation that patients present with at time of injury, including waiting for an available OR and appropriate nothing-by-mouth (nil per os) time 12,17 .…”

“…12 Prior studies have further suggested that the complication correlated to sedation is similar to that of general anesthesia and thus lends itself an appropriate modality to reduce operative burden. 12 Reducing the likelihood and incidence of infection is another primary goal in managing pediatric dog bite injuries. Mixed data on proper management of infected wounds have led to a lack of consensus on best management practice.…”

“…Furthermore, pit bulls are often the most identified breed 3,4,6,10 and are associated with higher injury severity 11 . Procedural sedation, which is a safe alternative to anesthesia, can be used to complete procedures or repair of injuries in pediatric patients in the ED 12 . Prior studies have further suggested that the complication correlated to sedation is similar to that of general anesthesia and thus lends itself an appropriate modality to reduce operative burden 12 .…”

“…11 Procedural sedation, which is a safe alternative to anesthesia, can be used to complete procedures or repair of injuries in pediatric patients in the ED. 12 Prior studies have further suggested that the complication correlated to sedation is similar to that of general anesthesia and thus lends itself an appropriate modality to reduce operative burden. 12 Reducing the likelihood and incidence of infection is another primary goal in managing pediatric dog bite injuries.…”