Pediatric Procedural Sedation and Analgesia (PROSA) in the Leuven University Hospitals: An Audit on Efficacy and Safety

Abstract

The hospital can be a stressful environment for a child. To address the increase in demands for pediatric procedural sedation, the PROSA team initiative was started in the Leuven University Hospitals in 2014. In this study, we assessed the efficacy and safety of this project since its initiation. Demographic (age, sex) and clinical (procedure, sedation method) data were prospectively registered by the dedicated PROSA team. Anonymized data (11/2014–6/2021) were extracted to a database for analysis. Data on 5090 procedures were available. The median age was 4.8 years. The sedation was successful in 98% of patients, be it classified as ‘technically difficult’ in 3.3%. Of the 2% of failed procedures, 69% were due to inadequate sedation and 31% to logistic reasons unrelated to sedation (such as puncture problem, suboptimal bowel preparation). The overall adverse event incidence was 2% and occurred predominantly during gastro-coloscopy or bronchoscopy. Pethidine/midazolam was used in 81 cases, nitrous oxide in 10 cases. A saturation decrease with oxygen supply was the documented adverse event in 83 cases. There were no deaths reported. With the current training and implementation, PROSA is effective with a success rate of 98% and an adverse event rate of 2%.

Intranasal Dexmedetomidine as Sedative for Medical Imaging in Young Children: A Systematic Review to Provide a Roadmap for an Evidence-guided Clinical Protocol

“…This does not mean that these non-pharmacological tools are not valuable to be considered in this age category, can either reduce or even replace drug exposure, and holds the promise of improve self-esteem and -control of the child. Procedure specific tools are -among others -MRI mock-up scanners, video or virtual reality systems, or ear protection to distract and reduce stress in patients, or a vacuum matress [2,3,4,26].…”

“…More than half of all children who undergo a procedure in the hospital experienced prior intense anxiety [2,3]. The focus on maximum anxiety and pain reduction during an intervention in children was one of the drivers to create the PROSA-team (PROcedural Sedation and Analgesia) within University Hospitals Leuven, as recently described in this journal [4]. During interventions, such dedicated teams apply both non-pharmacological and pharmacological approaches.…”

“…During interventions, such dedicated teams apply both non-pharmacological and pharmacological approaches. In addition to distraction and supportive therapy as non-pharmacological interventions, pharmacological interventions include fentanyl, midazolam, and more recently, also dexmedetomidine [4,5]. Specific during imaging procedures, avoiding uncontrolled behavior or movement artifacts is hereby of additional importance.…”

Intranasal Dexmedetomidine as Sedative for Medical Imaging in Young Children: A Systematic Review to Provide a Roadmap for an Evidence-Guided Clinical Protocol

“…The focus on maximal anxiety and pain reduction during an intervention in children was one of the drivers to create the PROSA-team (PROcedural Sedation and Analgesia) within University Hospitals Leuven, as recently described in this journal [ 4 ]. During interventions, such dedicated teams apply either non-pharmacological or pharmacological approaches, or both.…”

“…During interventions, such dedicated teams apply either non-pharmacological or pharmacological approaches, or both. In addition to distraction, vacuum mattresses or supportive therapy as non-pharmacological interventions, pharmacological interventions include fentanyl, midazolam, and—more recently—dexmedetomidine [ 4 , 5 ]. In particular during imaging procedures, avoiding uncontrolled behavior or movement artifacts is of additional importance.…”