Adverse Cardiovascular and Respiratory Events during Sedation of Pediatric Patients for Imaging Examinations

Sanborn, Pamela A.; Michna, Edward; Zurakowski, David; Burrows, Patricia E.; Fontaine, Paulette J.; Connor, Linda; Mason, Keira P.

doi:10.1148/radiol.2371041415

Cited by 165 publications

(95 citation statements)

References 22 publications

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“…This higher incidence of AE in patients with cerebral palsy could be attributed to multiple factors such as muscle tone, pharyngeal collapse, increased secretions and drug interactions with various medications used daily such as baclofen 20 . We excluded all patients with a recent active upper respiratory infection as sedation candidates as there are some publications which have elucidated to the higher risk of adverse events and sedation failure in these patients 21] The risk for AE in our patients with prematurity, gastrooesophageal reflux disease and cardiac disease was not statistically significant, although studies have shown that these patients are at higher risk for AE with sedation 15,22,23,24 . This study has several limitations.…”

Section: Discussionmentioning

confidence: 98%

Paediatric procedural sedation at a tertiary care university teaching hospital in India

Dubhashi

Silveira

Hebbar

et al. 2018

Sri Lanka J Child Health

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Section: Discussionmentioning

confidence: 98%

Paediatric procedural sedation at a tertiary care university teaching hospital in India

Dubhashi

Silveira

Hebbar

et al. 2018

Sri Lanka J Child Health

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“…This can largely be explained by differences in definitions [16], standards of care, the provider of sedation [15,[17][18][19], and sedation technique [20][21][22][23][24]. Previous cohorts have also included children undergoing painful or nonpainful procedures, and those involving the airway such as dental surgery or upper airway endoscopy, all of which require a wide variety of techniques, drugs and doses [25].…”

Section: Discussionmentioning

confidence: 99%

“…Age <6 months [13] or <1 year [15], ASA classification more than 2 [13,15,21,24], comorbid respiratory disease [20,24] or intellectual disabilities [29] are reportedly predictors of adverse events. We found that age <1 year and ASA classification >1 were risk factors for cardiopulmonary complications, which may arise as a consequence of differences in the anatomy and physiology of the infant airway [30], and the reduced cardiopulmonary reserve in sick children.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for adverse events during anesthesiologist-led sedation or anesthesia for diagnostic imaging in children: a prospective, observational cohort study

et al. 2015

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Background: Pediatric sedation for diagnostic radiological procedures remains the mainstay for adequate imaging quality. Objectives: To clarify the risk of adverse events during anesthesiologist-led sedation or anesthesia for diagnostic radiological procedures in children in order to improve quality of care. Methods: We enrolled children aged <15 years given sedation or anesthesia by an anesthesiologist and scheduled for computed tomography, magnetic resonance imaging, or nuclear medicine imaging November 2010-September 2014. We recorded adverse events occurring in the first 24 h. Results: Of 1,042 patients enrolled, adverse events were recorded in 254 (24.4%, 95% confidence interval [CI] 21.9 to 27.1). Adverse respiratory events occurred in 31 (3.0%), cardiovascular events in 7 (0.7%), sedation was prolonged in 165 (15.8%), there was one case of contrast allergy (0.01%), and there were 50 other minor complications (4.9%). Of the respiratory complications, there were 14 of airway obstruction (1.3%), 2 of apnea (0.2%), 14 of oxygen desaturation (1.3%), and one of laryngospasm (0.01%). There were no life threatening complications or consequences. Age <1 year (adjusted odds ratio [adjusted OR] 2.5, 95% CI 1.2 to 5.3) and American Society of Anesthesiologists (ASA) physical status classification 2 and 3 (adjusted OR 4.6, 95% CI 1.1 to 19.8, and adjusted OR 6.3, 95% CI 1.3 to 30.9, respectively) were risk factors for respiratory complications. Conclusions: Adverse events were common during sedation or anesthesia, but no life threatening or sentinel events occurred under experienced supervision. Caution should be exercised in children <1 year or with an ASA classification >1.

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“…A review of 16,467 elective sedations delivered by radiology nurses at Boston Children's Hospital, MA, reported a total of 70 (0.4%) pulmonary adverse events. There was no cardiac arrest and no need for intubation [17].…”

Section: Sedation Providersmentioning

confidence: 93%

“…Encouraging sleep deprivation with melatonin hormones before imaging may improve success, with or without sedation [6,17]. The success rate of sleep induced by feeding in term children younger than 3 years may be up to 75% [21].…”

Section: Techniquesmentioning

confidence: 99%

Sedation/anaesthesia in paediatric radiology

Arlachov¹,

Ganatra²

2012

The British Journal of Radiology

126

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Objectives In this article we will give a comprehensive literature review on sedation/general anaesthesia (S/GA) and discuss the international variations in practice and options available for S/GA for imaging children. Methods The key articles were obtained primarily from PubMed, MEDLINE, ERIC, NHS Evidence and The Cochrane Library. Results Recently, paediatric radiology has seen a surge of diagnostic and therapeutic procedures, some of which require children to be still and compliant for up to 1 h. It is difficult and sometimes even impossible to obtain quick and high-quality images without employing sedating techniques in certain children. As with any medical procedure, S/GA in radiological practice is not without risks and can have potentially disastrous consequences if mismanaged. In order to reduce any complications and practice safety in radiological units, it is imperative to carry out pre-sedation assessments of children, obtain parental/guardian consent, monitor them closely before, during and after the procedure and have adequate equipment, a safe environment and a well-trained personnel. Conclusion Although the S/GA techniques, sedative drugs and personnel involved vary from country to country, the ultimate goal of S/GA in radiology remains the same; namely, to provide safety and comfort for the patients. Advances in knowledge Imaging children under general anaesthesia is becoming routine and preferred by operators because it ensures patient conformity and provides a more controlled environment.

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Adverse Cardiovascular and Respiratory Events during Sedation of Pediatric Patients for Imaging Examinations

Abstract: Consideration should be given to using single agents, avoiding the use of multidrug sedation regimens, and recognizing that a history of pulmonary disease could be associated with an increased risk of adverse respiratory events despite a currently stable respiratory state.

Cited by 165 publications

References 22 publications

Paediatric procedural sedation at a tertiary care university teaching hospital in India

Paediatric procedural sedation at a tertiary care university teaching hospital in India

Incidence and risk factors for adverse events during anesthesiologist-led sedation or anesthesia for diagnostic imaging in children: a prospective, observational cohort study

Sedation/anaesthesia in paediatric radiology

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