Preprocedural fasting and adverse events in procedural sedation and analgesia in a pediatric emergency department: Are they related?

Roback, Mark G.; Bajaj, Lalit; Wathen, Joe E.; Bothner, Joan

doi:10.1016/j.annemergmed.2004.03.015

Cited by 126 publications

(79 citation statements)

References 14 publications

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“…This is consistent with previous work, including a study from our laboratory, demonstrating that the duration of fasting does not correlate with improved outcomes and that longer fasting times can even preclude the ability to sedate the patient adequately. 22,[42][43][44] However, on the basis of experience from procedures that were performed in an emergency department setting, limited evidence suggests that aspiration is more common in emergency procedures and nonfasted patients. 22,43 Thus, one must be careful when analyzing the risks and benefits of optimal fasting times until more comprehensive studies can be performed.…”

Section: Adverse Events and Risk Factorsmentioning

confidence: 99%

“…45 In addition, most of the complications in these studies occurred in patients who received Ն3 medications. 43 Previous literature has documented the importance of proper monitoring during pediatric sedation. 8,32 Children with chronic illnesses such as heart disease are reported to be at higher risk for sedation-related adverse events.…”

Section: Adverse Events and Risk Factorsmentioning

confidence: 99%

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Chloral Hydrate Sedation for Pediatric Echocardiography: Physiologic Responses, Adverse Events, and Risk Factors

Heistein

Ramaciotti²,

Scott³

et al. 2006

Pediatrics

100

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OBJECTIVE. The physiologic responses to chloral hydrate sedation in the setting of a pediatric echocardiography laboratory have not been well documented; neither has the population at risk been identified adequately. The purpose of this study was to describe the physiologic responses to chloral hydrate sedation, to report the occurrence of adverse events, and to identify any risk factors that predicted these adverse events in children who underwent sedation for echocardiography at our institution.METHODS. We analyzed retrospectively 1095 patients who were sedated for echocardiography. Vital signs and oxygen saturations were recorded every 5 minutes, and adverse events were noted. Potential risk factors for sedation-related adverse events were analyzed.RESULTS. Thirty-eight percent of patients were classified as American Society of Anesthesiologists class 3 or 4, reflecting the significant comorbidity in the study population. Hemodynamic responses to chloral hydrate sedation included Ն20% decreases in heart rate (24% of the patients) and blood pressure (59% of the patients). There were no deaths or permanent morbidity. Adverse events occurred in 10.8% of patients and included apnea (n ϭ 3 [0.3%]), airway obstruction (n ϭ 15 [1.4%]), hypoxia (n ϭ 65 [5.9%]), hypercarbia (n ϭ 40 of 603 [6.6%]), hypotension with poor perfusion (n ϭ 4 [0.4%]), vomiting (n ϭ 4 [0.4%]), and prolonged sedation (n ϭ 36 [3.3%]). No intervention was required in 92.5%, minor interventions were necessary in 7%, and major interventions were required in 0.5% of all patients. Multivariate analysis identified only age younger than 6 months as a predictor for adverse events, whereas cyanosis, hospitalization, American Society of Anesthesiologists class, fasting time, oxygen requirement, and use of additional sedation were not predictors.CONCLUSIONS. Moderate decreases in heart rate and blood pressure, in the absence of clinical deterioration, are expected responses to chloral hydrate sedation in this www.pediatrics.org/cgi

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Section: Adverse Events and Risk Factorsmentioning

confidence: 99%

Section: Adverse Events and Risk Factorsmentioning

confidence: 99%

Chloral Hydrate Sedation for Pediatric Echocardiography: Physiologic Responses, Adverse Events, and Risk Factors

Heistein

Ramaciotti²,

Scott³

et al. 2006

Pediatrics

100

View full text Add to dashboard Cite

show abstract

“…There are few published studies with adequate statistical power to provide guidance to the practitioner regarding safety or risk of pulmonary aspiration of gastric contents during procedural sedation. [104][105][106][107][108][109] When protective airway reflexes are lost, gastric contents may be regurgitated into the airway. Therefore, patients with a history of recent oral intake or with other known risk factors, such as trauma, decreased level of consciousness, extreme obesity, pregnancy, or bowel motility dysfunction, require careful evaluation before administration of sedatives.…”

Section: Before Emergency Sedationmentioning

confidence: 99%

“…It is likely that the risk of aspiration during procedural sedation differs from that during general anesthesia involving tracheal intubation or other airway manipulation. 104,105 However, because the absolute risk of aspiration during procedural sedation is not yet known, guidelines for fasting periods before elective sedation should generally follow those used for elective general anesthesia. For emergency procedures in children who have not fasted, the risks of sedation and the possibility of aspiration must be balanced against the benefits of performing the procedure promptly (see below).…”

Section: Dietary Precautionsmentioning

confidence: 99%

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

Coté¹,

Wilson²

2006

Pediatrics

518

150

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The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical supervision; careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications; appropriate fasting for elective procedures and a balance between depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure; a focused airway examination for large tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction; a clear understanding of the pharmacokinetic and pharmacodynamic effects of the medications used for sedation, as well as an appreciation for drug interactions; appropriate training and skills in airway management to allow rescue of the patient; age-and size-appropriate equipment for airway management and venous access; appropriate medications and reversal agents; sufficient numbers of people to carry out the procedure and monitor the patient; appropriate physiologic monitoring during and after the procedure; a properly equipped and staffed recovery area; recovery to presedation level of consciousness before discharge from medical supervision; and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children. INTRODUCTIONInvasive diagnostic and minor surgical procedures on pediatric patients outside the traditional operating room setting have increased in the last decade. As a consequence of this change and the increased awareness of the importance of providing analgesia and anxiolysis, the need for sedation for procedures in physician offices, dental offices, subspecialty procedure suites, imaging facilities, emergency departments, and ambulatory surgery centers has also markedly increased. In recognition of this need for both elective and emergency use of sedation in nontraditional

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“…Studier med ikke-fastende barn i traumemottak bedøvet med ketamin og midazolam uten intubasjon viste ingen økt forekomst av aspirasjon (13). Det er viktig å presisere at dette er en anestesi som krever tilstedevaerelse av anestesikyndig personale.…”

Section: Anestesi Ved øYeblikkelig Hjelpunclassified

Anestesi til barn

Østgaard¹,

Ulvik²

2010

Tidsskriftet

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Preprocedural fasting and adverse events in procedural sedation and analgesia in a pediatric emergency department: Are they related?

Cited by 126 publications

References 14 publications

Chloral Hydrate Sedation for Pediatric Echocardiography: Physiologic Responses, Adverse Events, and Risk Factors

Chloral Hydrate Sedation for Pediatric Echocardiography: Physiologic Responses, Adverse Events, and Risk Factors

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

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