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Re: Misleading paediatric sedation

Dear Editor

I read with interest the last article about paediatric sedation.[1] I feel that some of the evidence about adverse events is put forward in a slightly misleading way. Dr Doyle states that "...at least 52 deaths and 27 episodes of serious morbidity including six episodes of permanent neurological damage and 15 prolonged hospitalisations attributed to sedation. The causes of these events were mainly drug overdose, inadequate monitoring, inadequate training of the personnel involved, or premature discharge."[2] This statement is placed in the middle of a paragraph about sedation events occurring in emergency departments and might be taken to imply that these events occurred in emergency departments. This series about adverse sedation events was drawn from a wide variety of specialities. Indeed, 29 of the deaths occurred in dental practice and 11 in radiology. There were no deaths or permanent neurological injuries resulting from children sedated in emergency medicine and only 4 cases resulting in prolonged hospitalisation in this series. One would hope that the ability of emergency physicians to manage complications of sedation would exceed that of community dentists. It is easy to imagine how adverse events can occur in the dark, isolated corners of the radiology department. The safety of paediatric sedation is vexed and difficult question and it is important that the evidence, such as it is, is appraised correctly.

References

(1) Doyle E. Emergency analgesia in the paediatric population. Part IV Paediatric sedation in the accident and emergency department: pros and cons. Emer Med J 2002;19:284-287.

(2) Cote CJ, Notterman DA, Karl HW, Weinberg JA, McCloskey C. Adverse sedation events in Pediatrics: A Critical Incident Analysis of Contributing Factors. Pediatrics 2000; 105(4):805-814.