Procedural Sedation for Diagnostic Imaging in Children by Pediatric Hospitalists using Propofol: Analysis of the Nature, Frequency, and Predictors of Adverse Events and Interventions

• Published in: The Journal of pediatrics Vol. 160; no. 5; pp. 801 - 806.e1
• Main Authors: Srinivasan, Mythili, MD, PhD, Turmelle, Michael, MD, DePalma, Leanne M., MD, Mao, Jingnan, MS, Carlson, Douglas W., MD
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Elsevier Inc 01.05.2012; Mosby, Inc; Elsevier
• Subjects: Age Distribution; Biological and medical sciences; Child; Child, Preschool; children; Cohort Studies; Confidence Intervals; Conscious Sedation - adverse effects; Conscious Sedation - methods; Diagnostic Imaging; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug-Related Side Effects and Adverse Reactions - epidemiology; Drug-Related Side Effects and Adverse Reactions - etiology; Drug-Related Side Effects and Adverse Reactions - therapy; Female; Follow-Up Studies; General aspects; Health participants; Hospitals, Pediatric; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - adverse effects; image analysis; Incidence; Infant; Infant, Newborn; Logistic Models; Magnetic Resonance Imaging - methods; Male; Medical sciences; Multivariate Analysis; Odds Ratio; patients; Pediatrics; Predictive Value of Tests; Propofol - administration & dosage; Propofol - adverse effects; Public health. Hygiene; Public health. Hygiene-occupational medicine; Respiratory Insufficiency - chemically induced; Respiratory Insufficiency - epidemiology; Respiratory Insufficiency - therapy; Retrospective Studies; Risk Assessment; sedation; Sex Distribution; APC; Bag-mask ventilation; SLCH; American Society of Anesthesiologists; BMV; Ambulatory Procedure Center; St Louis Children’s Hospital; ASA; Human; Pediatrics; Health staff; Toxicity; Prediction; Physician; Hospital environment; Sedation; Life events; General anesthetic; Analysis; Secondary effect; Complication; Frequency; Medical imagery; Diagnosis; Hospital; Propofol; Predictive factor; Child
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2011.11.003

Objective To evaluate the nature, frequency, and predictors of adverse events during the use of propofol by pediatric hospitalists. Study design We reviewed 1649 charts of patients sedated with propofol by pediatric hospitalists at St Louis Children’s Hospital between January 2005 and September 2009. Results Hospitalists were able to complete 1633 of the 1649 sedations reviewed (99%). Major complications included 2 patients with aspiration and 1 patient intubated to complete the study. We observed a 74% reduction in the number of patients with respiratory events and airway interventions from 2005 to 2009. Predictors of respiratory events were history of snoring (OR, 2.40; 95% CI, 1.52-3.80), American Society of Anesthesiologists (ASA) physical status classification of ASA 3 (OR, 2.30; 95% CI, 1.22-4.33), age >12 years (OR, 4.01; 95% CI, 2.02-7.98), premedication with midazolam (OR, 1.85; 95% CI, 1.15-2.98), and use of adjuvant glycopyrrolate (OR, 4.70; 95% CI, 2.35-9.40). All except ASA 3 status were also predictors for airway intervention. There was a decline in the prevalence of all of these predictors over the study years ( P < .05) except for use of glycopyrrolate. Conclusion Our pediatric hospitalists implemented a successful propofol sedation program that realized a 74% reduction in respiratory events and airway interventions between 2005 and 2009. Decreased prevalence of the predictors of adverse events that we identified likely contributed to this reduction.