PediatricsWhen is a patient safe for discharge after procedural sedation? The timing of adverse effect events in 1,367 pediatric procedural sedations☆
Introduction
The ability of emergency physicians to provide safe and effective pediatric procedural sedation and analgesia is well established.1, 2, 3, 4, 5, 6 Extended emergency department (ED) recovery monitoring after procedural sedation and analgesia is commonplace because the occurrence of a serious adverse effect (eg, respiratory depression) without monitoring or after discharge may have dire and therefore unacceptable consequences. However, these lengthy recoveries require significant ED and personnel resources. The most appropriate duration of stay after a completed ED procedure has not been studied.
Using a prospectively collected database of procedural sedation and analgesias completed in our pediatric ED throughout a 2-year period, we attempted to determine the timing of adverse effects relative to drug administration and to identify factors that increase or decrease the risk of an adverse effect. We hope that delineation of the periods in which serious effects are most likely to occur will allow improvement in the standardization, development, and safety of procedural sedation and analgesia discharge criteria.
Section snippets
Materials and methods
Between May 1, 1997, and April 30, 1999, we prospectively accrued a database of 1,367 consecutive procedural sedation and analgesia events in a pediatric academic tertiary care medical center with an ED census of more than 50,000 patients annually. We have previously described the safety, efficacy, and resource use of this procedural sedation and analgesia sample.1, 2 The hospital's institutional review board reviewed and approved all data collection before the study period. A separate approval
Results
There were 1,367 procedural sedation and analgesia events performed during the study period, of which 26 were excluded because of subsequent patient hospitalization. No children were admitted to the hospital because of an adverse effect of the procedural sedation and analgesia or procedure. Characteristics of the remaining patients are shown in Table 1. We found adequate documentation about the timing and nature of adverse effects in 160 children (Figure 1).
The distribution of adverse effects
Discussion
Although adverse events in pediatric procedural sedation and analgesia have been reported and studied in the medical literature, our study specifically examines the timing of these events in relation to the procedure and the timing of medication administration. Safety must be the first concern in undertaking procedural sedation and analgesia, and the relevant literature to date has appropriately focused on attempts to characterize, identify, and reduce factors that may increase the risk of
Acknowledgements
We would like to acknowledge Henry E. Wang, MD, for his assistance in data analysis and in the preparation of this manuscript.
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2018, American Journal of Emergency MedicineCitation Excerpt :Based on these conditions, plus non-invasive monitoring and preoperative evaluation, the success rate of the PSA is again greatly improved [16,22]. For drug safety, a prospective descriptive study including 1215 patients suggested the success rate of sedation up to 98.6% [23], and the other study proved that adverse effects were common, but the serious adverse effects rarely occurred after 25 min from the final medication administration [24]. According to statistics, death events in the ED due to the PSA are more rare [25].
Training and Competency in Sedation Practice in Gastrointestinal Endoscopy
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Author contributions: SS and RDP designed and implemented the initial data collection and related training, designed the procedural sedation data sheet, and completed the first phase of data abstraction from the initial charts and data sheets. MMA and DHN conceived the study concept and design, abstracted the data in the second phase, and completed all data analysis and general study organization. DHN takes responsibility for the paper as a whole.
Presented in abstract form at the American College of Emergency Physicians Scientific Assembly, Chicago, IL, October 2001.
The authors report this study did not receive any outside funding or support.
Reprints not available from the authors.