The Impact of a Dedicated Sedation Team on the Incidence of Complications in Paediatric Procedural Analgosedation (original) (raw)
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Children
The hospital can be a stressful environment for a child. To address the increase in demands for pediatric procedural sedation, the PROSA team initiative was started in the Leuven University Hospitals in 2014. In this study, we assessed the efficacy and safety of this project since its initiation. Demographic (age, sex) and clinical (procedure, sedation method) data were prospectively registered by the dedicated PROSA team. Anonymized data (11/2014–6/2021) were extracted to a database for analysis. Data on 5090 procedures were available. The median age was 4.8 years. The sedation was successful in 98% of patients, be it classified as ‘technically difficult’ in 3.3%. Of the 2% of failed procedures, 69% were due to inadequate sedation and 31% to logistic reasons unrelated to sedation (such as puncture problem, suboptimal bowel preparation). The overall adverse event incidence was 2% and occurred predominantly during gastro-coloscopy or bronchoscopy. Pethidine/midazolam was used in 81 c...
Sedation and analgesia in children undergoing invasive procedures
Archivos argentinos de pediatría
Introduction. As a result of the increased number of both diagnostic and therapeutic procedures in pediatric outpatients, sedation and analgesia have gained relevance in this context. Objective. To characterize the type of sedation and analgesia used by pediatric sedation teams in procedures done outside the operating room, as well as its safety and outcome. Population and Methods. All procedures performed in 1 month to 5 year old patients under intravenous sedation with midazolam, ketamine, propofol or lidocaine were analyzed over a 14-month period. The Ramsay sedation scale and the CHEOPS pain scale were used to determine the response to the sedation and analgesia administered. Results. A total of 186 procedures were analyzed. The results of the evaluation of response to sedation and analgesia indicated that an adequate deep sedation was obtained in 98% of cases, and that an adequate analgesia was achieved in 92% of patients. Around 12% of the procedures were associated with adverse events, all related to the airways, and none was serious. The only statistically significant endpoint associated with adverse events were procedures which involved airway interventions, i.e., fibrobronchoscopy, upper gastrointestinal endoscopy or transesophageal echocardiogram, with an OR of 6.27 (95% CI: 1.28-30.63; p = 0.023). Conclusions. In this group of patients, intravenous outpatient sedation and analgesia administered by a specialized team were safe and effective.
International Journal of Emergency Medicine, 2008
Background Although young age is considered a risk factor for adverse events related to procedural sedation and analgesia (PSA), data in very young children (<2 years of age) are lacking. Aims The main objective of our study is to describe PSA in children <2 years of age in an inner city tertiary care pediatric emergency department (PED). Methods We conducted a retrospective chart review from January 2005 to June 2007 of children <2 years of age who received PSA in our PED. We collected demographic variables, indication for and medications used for PSA, adverse events (AE) related to PSA, and interventions performed to treat them. Results Of the children who received PSA, 14.5% (180/ 1,235) were <2 years of age of whom 173 were included for the analysis; 73% (126/173) of the study subjects were between 1 and 2 years of age, 54.3% (94/173) were male, and 96.5% (167/173) belonged to American Society of Anesthesiologists class 1. Incision and drainage (45.0%, 78/173) and laceration repair (32.4%, 56/173) were the two most common indications for PSA. Ketamine and midazolam was the most common combination medication used for PSA (62.4%, 108/173). Sedation was deemed ineffective in 5.8% (10/173) of the children. There were only two failed sedations; 5.8% (10/173) of the children experienced AE with most being minor [oxygen desaturations 1.7% (3/173), emesis 2.3% (4/173), and others 1.2% (2/173)]. One child experienced serious AE in the form of apnea and bradycardia requiring intubation. Conclusions Our data suggest that children under 2 years of age can be sedated effectively without increased risk of AE in a PED.
European journal of emergency medicine : official journal of the European Society for Emergency Medicine, 2017
Paediatric patients receive less procedural sedation and analgesia (PSA) in the emergency department compared with adults, especially in countries where emergency medicine is at an early stage of development. The objectives of this study were to evaluate the adverse events and efficacy of paediatric PSA in a country with a recent establishment of emergency medicine and to describe which factors aided implementation. This is a prospective, multicentre, observational study of paediatric patients undergoing PSA by the first trained emergency physicians (EPs) in The Netherlands. A standardized data collection form was used at all participating hospitals to collect data on adverse events, amnesia, pain scores, and procedure completion. A survey was used to interpret which factors had aided PSA implementation. We recorded 351 paediatric PSA. The mean age was 9.5 years (95% confidence interval: 9.1-10.0). Esketamine was most frequently used (42.4%), followed by propofol (34.7%). The advers...
Procedural sedation and analgesia in children
The Lancet, 2006
Procedural sedation and analgesia for children-the use of sedative, analgesic, or dissociative drugs to relieve anxiety and pain associated with diagnostic and therapeutic procedures-is now widely practised by a diverse group of specialists outside the operating theatre. We review the principles underlying safe and effective procedural sedation and analgesia and the spectrum of procedures for which it is currently done. We discuss the decision-making process used to determine appropriate drug selection, dosing, and sedation endpoint. We detail the pharmacopoeia for procedural sedation and analgesia, reviewing the pharmacology and adverse effects of these drugs. International differences in practice are described along with current areas of controversy and future directions.
Pediatric sedation and analgesia in a developing country
Journal of Anesthesia and Clinical Research
The management of acute pain and anxiety in children undergoing diagnostic and therapeutic procedures has developed substantially in the past two decades. An increase in the numbers of investigations and non-surgical interventions in children has created an enormous demand for sedation services. Procedural sedation and analgesia for children is now widely practiced by a various group of the specialists. The goal of procedural sedation is the safe and effective control of pain, anxiety and motion as well as to provide an appropriate degree of memory loss or decreased awareness. Short acting, rapid onset drugs with little adverse effects and improved safety profiles are replacing outdated regimens. This article is to discuss the decision making process used to determine appropriate drug selection, dosing and sedation endpoint. It also reviews the current status of sedation and analgesia for pediatric procedures in a developing country.