The Impact of a Dedicated Sedation Team on the Incidence of Complications in Pediatric Procedural Analgosedation

Abstract

The number of pediatric procedural sedations for diagnostic and minor therapeutic procedures performed outside the operating room has increased. Therefore, we established a specialized interdisciplinary team of pediatric anesthesiologists and intensivists (Children’s Analgosedation Team, CAST) at our tertiary-care university hospital and retrospectively analyzed the first year after implementation of the CAST. Within one year, 784 procedural sedations were performed by the CAST; 12.2% of the patients were infants <1 year, 41.9% of the patients were classified as American Society of Anesthesiologists (ASA) grade III or IV. Most children received propofol (79%) and, for painful procedures, additional esketamine (48%). Adverse events occurred in 51 patients (6.5%), with a lack of professional experience (OR 0.60; 95% CI 0.42–0.81) and increased propofol dosage (OR 1.33; 95% CI 1.17–1.55) being significant predictors. Overall, the CAST enabled safe and effective procedural sedation in children outside the operating room.

Safety and quality in paediatric procedural sedation: what really matters?

“…Beyond standards for structural aspects of procedural sedation, qualification of sedation personnel has been shown to be one of the major contributors to patient safety [12,27,28].…”

“…Numerous studies have identified significant risk factors for adverse events related to patient, sedation and procedure (Table 1) [9][10][11][12][13][14]. Adverse events require immediate and competent management, but ideally they are anticipated, and appropriate measures are adopted proactively.…”

“…Small teams with well trained personnel enable a rapid acquisition of experience within the team and structured training of new team members. A regular and frequent conduct of sedations in such a context leads to a significant reduction of adverse events and procedural failures [4 ▪ ,12,31].…”

Parental preferences for the procedural sedation of children in dentistry: a discrete choice experiment

“…Identifying attributes and their levels is the most important step to ensure the validity of the DCE (29). In this study, the attributes and their levels were specified using literature reviews (15,23,(30)(31)(32)(33)(34)(35)(36), interviews with parents of pediatric dental patients, and expert consultation. Thus, the DCE used in our study included 6 attributes recorded at 3 or 4 levels.…”

Risk Factors on the Adverse Events of Sedation for Diagnostic Tests in Pediatric: A Retrospective Case–Control Analysis

“…With the concept of comfortable medical treatment, pediatric sedation is steadily developing for a growing number of non-invasive and painless examinations, such as CT, MRI, echocardiography, electroencephalogram and lung function. Meanwhile, the rapid growth of medical units for pediatric procedural sedation in China, and the widely ranged use of drugs and techniques in pediatric sedation, have resulted in a significant difference between sedation levels, effectiveness and associated risks [4]. Some studies have reported the sedation-related adverse event rates ranging from 6.5% to 22.02% [4][5][6].…”