<p>Serious Adverse Events in Pediatric Procedural Sedation Before and After the Implementation of a Pre-Sedation Checklist</p>

Abstract

Objective: Procedural sedation is considered by the Joint Commission on Accreditation of Healthcare Organizations as a high-risk procedure when performed in the emergency department (ED). A pre-sedation checklist is a set of items checked before any sedation. We evaluated the impact of a pre-sedation checklist on the rate of serious adverse events (SAE) in a pediatric ED. Methods: We conducted a retrospective study comparing the rate of SAE in children treated with the combination of ketamine and propofol before and after the implementation of a presedation checklist. The before-and-after periods lasted from 1.1.2013 to 30.6.2016 and from 1.7.2016 to 30.6.2019, respectively. Patient data were extracted from the electronic medical records using an integrated business intelligence information system. Results: The before-and-after cohorts included 1349 and 1846 patients, respectively. The two groups were similar with regard to age, sex, length and type of procedure, medications dosage, and level of physicians' training. A total of 183/1349 (13.5%) and 420/1846 (22.7%) SAE were recorded during the before-checklist and after-checklist periods, respectively (p<0.0001). The rates of laryngospasm, apnea, and oxygen saturation ≤90% at the beforeand-after checklist periods were 9/1349 (0.6%) and 30/1846 (1.6%); p<0.05, 48/1349 (3.5%) and 77/1846 (4.2%); p=0.37, and 123/1349 (9.1%) and 312/1846 (16.9%); p< 0.0001, respectively. All the SAE were successfully managed by the emergency physicians and no patient required hospitalization due to a SAE. Conclusion: In this large cohort of ED children who underwent deep sedation, the administration of a pre-sedation checklist was not associated with a reduction in SAE rate.

Pediatric Emergency Medicine Fellowship Procedural Sedation Training

“…A checklist can be helpful to identify critical items learners should demonstrate during simulated or live proctored sedations. Additional tools that can be used to assess competency include written (Appendices 2 and 3) and/or oral assessments, numeric case thresholds, and learner driven synthesis of products, such as lectures and treatment guidelines 18,31 …”

“…Additional tools that can be used to assess competency include written (Appendices 2 and 3) and/or oral assessments, numeric case thresholds, and learner driven synthesis of products, such as lectures and treatment guidelines. 18,31 Each core ACGME competency can be mapped to a specific PPS component with suggested tools for assessment (Table 2). Regardless of how program directors aim to measure competency, it is important that all evaluators be appropriately trained on the purpose and appropriate implementation of the assessment tool.…”

Pediatric sedation for emergency, imaging and endoscopic procedures: a worldwide review from the last five years

“…[9][10][11]15,16 Main associated side effects include respiratory depression, hypoxemia, hypotension, laryngospasm and rare complaints of nausea and vomiting. 14,17,18 Dexmedetomidine proved to be favorable for pediatric sedation in a monotherapy regimen, considering its balanced hypnosis, similar to physiological sleep, and also its analgesic potential. So far, safe use of this drug in the studied population is restricted to the intravenous route, as a continuous infusion, with doses ranging from 0.2 to 0.7 mcg/ kg/h.…”

“…Combined use with Fentanyl increases the risk of significant respiratory depression. Librov, 2020 18 Lam, 2018 2…”

“…Forrester, 2018 7 Homma, 2020 10 Librov, 2020 18 Schlegelmilch, 2021 3 Azarfar, 2022 11 EV Bolus: 0,5 -1 Intranasal route was considered the best option for analgesia in emergencies.…”