The number of pediatric procedural sedations for diagnostic and minor therapeutic procedures performed outside the operating room has increased. Therefore, we established a specialized interdisciplinary team of pediatric anesthesiologists and intensivists (Children’s Analgosedation Team, CAST) at our tertiary-care university hospital and retrospectively analyzed the first year after implementation of the CAST. Within one year, 784 procedural sedations were performed by the CAST; 12.2% of the patients were infants <1 year, 41.9% of the patients were classified as American Society of Anesthesiologists (ASA) grade III or IV. Most children received propofol (79%) and, for painful procedures, additional esketamine (48%). Adverse events occurred in 51 patients (6.5%), with a lack of professional experience (OR 0.60; 95% CI 0.42–0.81) and increased propofol dosage (OR 1.33; 95% CI 1.17–1.55) being significant predictors. Overall, the CAST enabled safe and effective procedural sedation in children outside the operating room.
Demands in procedural sedation and analgesia in children are growing as the number of diagnostic and minor therapeutic procedures performed on paediatric patients outside the operating room setting has increased. We established a specialized interdisciplinary team of paediatric anaesthesiologists and paediatric intensivists (Children’s Analgosedation Team, CAST) for diagnostic and therapeutic procedures and aimed to analyse the incidence and risk factors of adverse events. A retrospective analysis of data collected in the first year after implementation of the interdisciplinary CAST at our tertiary care university hospital was conducted. Within one year, 784 procedural sedations were performed by the CAST. 7.4% of the patients were infants < 1 year of age. 53% of the patients were classified as American Society of Anesthesiologists (ASA) status III or IV. Most children received propofol (79%) and for painful procedures, additional esketamine (48%). Adverse events occurred in 51 patients (6.5%), most frequently apnoea (1.7%), airway obstruction (1%), and problems with the intravenous access (1%). Cancellation of the procedure occurred in four cases (0.5%). Lack of experience (OR 0.60; 95% CI 0.42-0.81) and increasing propofol dosage of 1mg kg-1 (OR 1.33; 95% CI 1.17-1.55) were identified as predictors for adverse events. ASA classification did not reveal a significant difference in complication rates. Conclusion: Increasing dosage of propofol and lack of experience were associated with adverse events in paediatric analgosedation for brief diagnostic or therapeutic procedures. Trial registration number: NCT04760249 (retrospectively registered on February 7th, 2021)
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