Outcome of pediatric procedural sedation & analgesiain a tertiary care hospital in Pakistan

Abstract

Background and Objective:Procedural sedation and analgesia (PSA) is pharmacologically induced state which allows patients to tolerate painful procedures while maintaining protective reflexes. It is the standard of care but there is limited data from Pakistan. Our objective was to assess the safety of the procedural sedation and analgesia in pediatric population at a tertiary care setting.Methods:A retrospective notes and record review was conducted at the Aga Khan University Hospital, Karachi over 4 years from April 2010 to August 2014. Patients were between ages 6 months to 16 years and were in low risk category. The combination of Ketamine and Propofol were used. Data collected on the standardized hospital PSA form. All procedures were performed by two trained persons.Results:A total of 3489 diagnostic and therapeutic procedures were performed. Satisfactory level of sedation was achieved for 3486 (99%) of procedures. Adverse events occurred in 21 (0.6%) patients including: 12 (0.3%) episodes of hypoxia, 07 (0.2%) episodes of apnea, 02 (0.06%) episodes of post sedation hallucination. No major events were noted.Conclusion:Procedural sedation & analgesia for children using Propofol and Ketamine is found safe and effective in our setting.

Safety and Efficacy of Procedural Sedation and Analgesia in Pediatric Oncology Patients

“…The evaluation of 1216 procedures included in our study showed safety and efficacy comparable to another study conducted by Haque et al, but the range of procedures assessed in our study is much larger [8]. In this study, we observed that a propofol dose of 1 mg/kg was enough for most patients in contrast to other studies in which higher doses were used [8][9]. There are other safe combinations like Mahajan et al suggested other combinations such as fentanyl and midazolam which are considered a safe regimen in children [16].…”

“…Relief from anxiety and procedural pain is ethically imperative in treating children from the fact that they tend to have short-and long-term physiological, physical as well as a psychological effect because of untreated pain [8]. Therefore, procedural sedation, described as the administration of medication for minimizing pain and awareness of the patients, is termed as the standard practice in the pediatric department's world over for facilitating procedures [9]. Although sedation is usually safe, it is sometimes associated with serious adverse events (SAEs).…”

“…Critical aspects of PSA include pre-procedural evaluation of the patients, constant monitoring of the child before, during and after the procedure, proper procedure documentation, equipment as well as the staff needed in addition to the type of medication that is recommended [3]. Various national and international studies done on this topic have reported evaluating these outcomes in pediatric departments, but specifically, in oncology units, such studies are only a handful [4,[7][8][9].…”

Anxiety of parents and children undergoing gastrointestinal endoscopy correlates with sedative doses

“…In our study, Group H-S required more ketamine and propofol than Group L-S. Likewise our study, other studies administered both ketamine and propofol with or without premedication to children in procedural sedations [4,12,13]. In a study with 125 children, who had a procedure in the emergency department, only ketamine was administered as a sedative agent and required more doses (1.5-2 mg/kg) than in our study, in which we used multimodal sedatives ( 14).…”

he outcome of Ketamine and Propofol for Procedural Sedation and Analgesia (PSA) in Pediatric Patients in the Emergency Department: A Cross-Sectional Study

“…However, pain assessment was recorded pre and post-procedure (during recovery). 8 The patient was discharged only when able to maintain good airway, was fully awake, presence of swallowing reflex, with ability to swallow clear liquids, and achieving the pre-sedation level of responsiveness.…”