Risk Reduction in Pediatric Procedural Sedation by Application of an American Academy of Pediatrics/American Society of Anesthesiologists Process Model

Hoffman, George M.; Nowakowski, Richard S.; Troshynski, Todd J.; Berens, Richard J.; Weisman, Steven J.

doi:10.1542/peds.109.2.236

Cited by 284 publications

(181 citation statements)

References 40 publications

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“…Hence, there is minimal risk to the patient undergoing the sedative procedure. Recently, Hoffman et al 14 noted that 22% of children who are scheduled for conscious sedation using less potent sedatives (chloral hydrate, midazolam, fentanyl) actually achieve deep sedation. The complication rate (hypoxia, airway obstruction, aspiration, hypotension, bradycardia) was 3.8% in patients who remained conscious and 5.6% in patients who were deeply sedated.…”

Section: Discussionmentioning

confidence: 99%

Conscious Sedation of Children With Propofol Is Anything but Conscious

2004

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ABSTRACT. Objective. To determine the depth of sedation required for bone marrow aspiration and intrathecal injection of chemotherapeutic agents in children using a bispectral (BIS) index monitor and clinical assessment by an independent observer.Methods. Sixteen children who were undergoing 19 intrathecal chemotherapy and bone marrow aspirations were enrolled in the study. Their ages ranged from 23 months to 190 months with a mean of 79 months. The BIS index was recorded every 5 minutes by an independent observer. The patients received only intravenous propofol for sedation. There were no complications during the procedures.Results. The mean BIS score was 62.8 ؎ 9.6. The mean low BIS score was 29.7 ؎ 13.7, indicating a level of deep sedation and/or general anesthesia was necessary to induce the desired stated of consciousness that would permit the practitioner to perform the procedure.

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Section: Discussionmentioning

confidence: 99%

Conscious Sedation of Children With Propofol Is Anything but Conscious

2004

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“…However, hypoxias, elevations of blood pressure and heart rate have repeatedly been demonstrated during gastroscopy (1)(2)(3)(4)(5). These potentially harmful sideeffects are sometimes life-threatening, particularly for patients with accompanying disease.…”

Section: Discussionmentioning

confidence: 99%

“…Although hypotension and hypertension during endoscopy very rarely result in permanent complications, they occasionally reach levels for which corrective action is appropriate. Atrial or ventricular arrhythmias are rarely precipitated by sedation or stress of the procedure (4,5,7,12,17,18). In works of Deenadayalu et al (19) a worldwide multicenter safety review of more than 521,000 patients was conducted.…”

Section: Discussionmentioning

confidence: 99%

“…But sedation or general anaesthesia are not complication free applications. Furthermore endoscopic procedures are frequently performed outside the operating room (1)(2)(3)(4)(5). Significant complications during such procedures have been reported (6).…”

Section: Introductionmentioning

confidence: 99%

“…Increased awareness of the complications associated with sedation during GI endoscopic procedures in children, the institution of modern monitoring modalities to identify these complications, and the involvement of the anaesthesiologists in looking after these children in, or outside, the operating room is optimal for the safety of these patients (1)(2)(3)(4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

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Retrospective analysis of deep sedation in pediatric population for endoscopic procedures: adverse events and outcomes

et al. 2015

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Reevaluating Fasting for Procedural Sedation

2018

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Procedural sedation is widely administered by a variety of practitioners to facilitate painful or frightening procedures in children. [1][2][3][4][5][6][7][8][9] Guidelines 9 recommend a minimum period of fasting (nothing by mouth) prior to elective sedation because of concerns about pulmonary aspiration. [7][8][9] These guidelines most commonly mirror thresholds fixed for elective general anesthesia: 2 hours or longer for clear liquids, 4 hours or longer for breast milk, and 6 hours or longer prior for cow milk, infant formula, or a light meal. 9 Compliance with these requirements-whether for procedural sedation or for general anesthesia-comes at a cost to the child, the family, and to health care delivery. Fasting can be uncomfortable and distressing, 10 can cause dehydration 10 and hypoglycemia, 11 and is associated with decreased sedation efficacy 12 and more frequent sedation failure. 13 In clinical practice, it is common for minimum fasting durations to be substantially exceeded. 14 To minimize the potential for misunderstanding, patients may be intentionally instructed to fast longer, because an instruction of "nothing by mouth after midnight" is less complicated and error prone than separate thresholds for light meals vs breast milk vs clear fluids. Delays in starting scheduled procedures further extend fasting times. 14,15 Children with fasting violations risk lengthy procedure postponement or cancellation.The emergency department (ED) provides an ideal setting to scientifically evaluate the impact of fasting, because restricting oral intake after midnight cannot apply to patients requiring sedation for emergent and urgent procedures. On a daily basis, children in the ED require procedures (eg, laceration repair, abscess drainage, fracture and dislocation reduction, and diagnostic imaging) that must be promptly performed despite noncompliance with elective fasting guidelines. [2][3][4][5][6][7][8] Despite such regular ongoing performance of nonfasted sedation over decades, the ED has not been identified as a setting at greater risk for aspiration. [1][2][3]7,8 In this issue of JAMA Pediatrics, Bhatt et al 3 studied fasting guideline noncompliance for ED procedural sedation. In their multicenter, prospective, observational study, most children (3284 of 6183) receiving procedural sedation were noncompliant with standard elective fasting guidelines (vs 2899 who complied with fasting guidelines for solids and liquids) 9 and, despite this, were no more likely to vomit or experience other adverse events. No aspiration was observed in any child, whether compliant or noncompliant with fasting. These findings confirm multiple similar but smaller prior ED studies in the last 15 years 4-6 and a study including an ED subset. 1 The ED experience thus has consis-

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Risk Reduction in Pediatric Procedural Sedation by Application of an American Academy of Pediatrics/American Society of Anesthesiologists Process Model

Abstract: Presedation assessment reduces complications of DS. Repeated assessment of sedation score reduces the risk of inadvertent DS. The data provide direct evidence that AAP/ASA guidelines can reduce the risk of pediatric procedural sedation.

Cited by 284 publications

References 40 publications

Conscious Sedation of Children With Propofol Is Anything but Conscious

Conscious Sedation of Children With Propofol Is Anything but Conscious

Retrospective analysis of deep sedation in pediatric population for endoscopic procedures: adverse events and outcomes

Reevaluating Fasting for Procedural Sedation

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