Adverse events of procedural sedation and analgesia in a pediatric emergency department*

https://doi.org/10.1016/S0196-0644(99)80050-XGet rights and content

Study objective: To determine the adverse event and complication rate for the use of procedural sedation and analgesia for painful procedures and diagnostic imaging studies performed in a pediatric emergency department.

Methods: This prospective case series was conducted in the ED of a large, urban pediatric teaching hospital. Subjects were patients younger than 21 years seen between August 1997 and July 1998, who required intravenous, intramuscular, oral, rectal, intranasal, or inhalational agents for painful procedures or diagnostic imaging. All patients who underwent procedural sedation and analgesia were continually monitored. Adverse events and complications were recorded. The ED controlled substance log was checked weekly and all sedations were reviewed. Adverse events were defined as follows: oxygen desaturation less than 90%, apnea, stridor, laryngospasm, bronchospasm, cardiovascular instability, paradoxical reactions, emergence reactions, emesis, and aspiration. Complications were defined as adverse events that negatively affected outcome or delayed recovery.

Results: Of 1,180 patients who underwent procedural sedation and analgesia in the ED, 27 (2.3%) experienced adverse events, which included oxygen desaturation less than 90% requiring intervention (10 patients) [supplemental oxygen (9), bag-mask ventilation (1)], paradoxical reactions (7), emesis (3), paradoxical reaction and oxygen desaturation requiring supplemental oxygen (2), apnea requiring bag-mask ventilation (1), laryngospasm requiring bag-mask ventilation (1), bradycardia (1), stridor and emesis (1) and oxygen desaturation requiring bag-mask ventilation with subsequent emesis (1). There was no statistically significant difference in mean doses for all procedural sedation and analgesia medication regimens between those children who experienced adverse events and those who did not. No single drug or drug regimen was associated with a higher adverse event rate. In addition, there was no significant difference in the adverse event rate between males and females, among the different ages, or among the different indications for procedural sedation and analgesia. No patient required reversal of sedation with naloxone or flumazenil, endotracheal intubation, or hospital admission because of complications from procedural sedation and analgesia.

Conclusion: The adverse event rate for procedural sedation and analgesia performed by pediatric emergency physicians was 2.3% with no serious complications noted.

References (39)

  • RodrigoMR et al.

    Effect of conscious sedation with midazolam on oxygen saturation

    J Oral Maxillofac Surg

    (1988)
  • American College of Emergency Physicians

    Clinical policy for procedural sedation and analgesia in the emergency department

    Ann Emerg Med

    (1998)
  • MalviyaS et al.

    Adverse events and risk factors associated with the sedation of children by nonanesthesiologists

    Anesth Analg

    (1997)
  • YasterM et al.

    Midazolam-fentanyl intravenous sedation: Case report of respiratory arrest

    Pediatrics

    (1990)
  • StrainJD et al.

    IV nembutal: Safe sedation for children undergoing CT

    Am J Radiol

    (1988)
  • GreenbergSB et al.

    High dose chloral hydrate sedation for children undergoing CT

    J Comput Assist Tomogr

    (1991)
  • CotéCJ et al.

    Sedation disasters: adverse drug reports in pediatrics—EDA, USP and others

    Anesthesiology

    (1995)
  • Committee on Drugs

    Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures

    Pediatrics

    (1992)
  • Joint Commission on Accreditation of Healthcare Organizations
  • Cited by (251)

    • Practice of sedation-analgesia in emergency departments

      2022, Journal Europeen des Urgences et de Reanimation
    View all citing articles on Scopus
    *

    Presented at the American Academy of Pediatrics annual meeting, San Francisco, CA, October 1998.

    View full text