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

Abstract

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.

Incidence and Causes of Adverse Events in Diagnostic Radiological Studies Requiring Anesthesia in the Wake-Up Safe Registry

“…Given the inconsistent definitions of AEs, limited definitions of the population at risk across studies, and lack of data on specific reasons for AEs, evaluating the sum of these findings is a significant challenge. 9 Overcoming many of these limitations, the Wake-Up Safe (WUS) multi-institutional registry includes consistently recorded data for serious AEs associated with pediatric anesthesia care. 10 The WUS registry collects demographic information on patients receiving anesthetic care at participating institutions and provides detailed information regarding perioperative medications, anesthetic techniques, and perioperative morbidity.…”

“…Other studies presented only procedural sedation data, whereas some combined radiological studies with other applications of procedural sedation or GA in off-site locations. Given the inconsistent definitions of AEs, limited definitions of the population at risk across studies, and lack of data on specific reasons for AEs, evaluating the sum of these findings is a significant challenge 9 . Overcoming many of these limitations, the Wake-Up Safe (WUS) multi-institutional registry includes consistently recorded data for serious AEs associated with pediatric anesthesia care 10 .…”