Recovery characteristics and parental satisfaction in pediatric procedural sedation

Abstract

Background Despite being a standard of care for children undergoing stressful procedures, little data exist on parental perception of pediatric sedation. Aims This study aimed to investigate recovery characteristics and parental satisfaction for pediatric sedations performed with four widely used sedative regimens. Methods A prospective observational study was conducted at the Institute for Maternal and Child Health of Trieste, Italy, enrolling children undergoing procedural sedation with one of the following pharmacological regimens: propofol, propofol + midazolam, ketamine + propofol, and dexmedetomidine + midazolam. A questionnaire was used to assess the occurrence of symptoms upon recovery from sedation and the following day, and the caregivers' satisfaction for both the recovery pattern and the overall sedation experience, according to a numerical rating scale (0–10). Answers were collected through a telephone survey. The primary outcome was the difference in the quality of the recovery as perceived by caregivers; the secondary and tertiary outcomes were the perceived quality of the overall sedation experience and the frequency of sedation‐related adverse events, respectively. Results Data from 655 patients, 149 receiving propofol, 245 propofol + midazolam, 134 ketamine + propofol, and 127 dexmedetomidine + midazolam, were analyzed. The level of parents' satisfaction for both the recovery and the sedation experience was overall high and increased with the patients' age in all the pharmacological groups (Spearman's rank correlation, ρ .083, p = .033, and ρ .087, p = .026, respectively), with no statistically significant differences between groups when adjusting for age. The occurrence of irritability, prolonged sleepiness, hyperactivity, unsteadiness, hallucinations, emesis, and respiratory distress at any moment negatively affected parental satisfaction. Conclusions In this study, caregivers' satisfaction with pediatric sedation was high, regardless of the regimen used. Lower parental satisfaction was associated with younger age, irritability after sedation, prolonged sleepiness, hyperactivity, unsteadiness, hallucinations, emesis, and respiratory distress.

Nurses’ Perceptions of the Quality of Procedural Sedation in Children Comparing Different Pharmacological Regimens

“…This is an interesting and understudied area of work. In the literature, few studies are available about caregivers’ perception of pediatric peri-procedural sedation and in most of the cases, parents’ satisfaction is high regardless of the sedative drug used [ 5 , 8 , 9 ]. While several factors are reported to influence parental satisfaction, such as environment, timeliness and communication issues, the most relevant one is the quality of the child’s recovery from sedation [ 5 , 6 , 9 , 10 ].…”

“…In the literature, few studies are available about caregivers’ perception of pediatric peri-procedural sedation and in most of the cases, parents’ satisfaction is high regardless of the sedative drug used [ 5 , 8 , 9 ]. While several factors are reported to influence parental satisfaction, such as environment, timeliness and communication issues, the most relevant one is the quality of the child’s recovery from sedation [ 5 , 6 , 9 , 10 ]. However, parents’ perceptions may be limited by a lack of knowledge about the different available drug regimens and by the experience of only one or limited types of sedation in their child.…”

“…Throughout this study, the main factors affecting the level of nurses’ satisfaction were the presence of AE and parental/children satisfaction. What we already know about caregivers’ satisfaction for pediatric sedation is that experiencing post-sedation respiratory distress, vomiting, irritability, hyperactivity and hallucinations are all independent risk factors for parental lower satisfaction scores [ 9 ]. Similar results were obtained also in this nurses’ survey.…”

Safety and quality in paediatric procedural sedation: what really matters?

“…Medications with brief onset and recovery times are preferred for procedural sedation. Avoiding agitation, hyperactivity and vomiting are important factors as well, having a major influence on the satisfaction with procedural sedation experienced by children and caregivers alike [32 ▪▪ ]. Depending on the procedure itself and on the comorbidities of the child, either a single sedative or a combination of sedative and analgetic medication is used.…”