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Adverse Events of Procedural Sedation and Analgesia in A Pediatric Emergency Department

This study examined adverse events from procedural sedation and analgesia administered in a pediatric emergency department over one year. Of the 1,180 patients who received sedation, 27 (2.3%) experienced adverse events such as oxygen desaturation, paradoxical reactions, emesis, apnea, laryngospasm, bradycardia, or stridor and emesis. However, no patients required interventions like naloxone, intubation, or hospital admission due to sedation complications. The mean sedation doses did not differ between those with and without adverse events. No single drug or regimen had a higher adverse event rate based on age, gender, or procedure type. The overall adverse event rate was low

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53 views1 page

Adverse Events of Procedural Sedation and Analgesia in A Pediatric Emergency Department

This study examined adverse events from procedural sedation and analgesia administered in a pediatric emergency department over one year. Of the 1,180 patients who received sedation, 27 (2.3%) experienced adverse events such as oxygen desaturation, paradoxical reactions, emesis, apnea, laryngospasm, bradycardia, or stridor and emesis. However, no patients required interventions like naloxone, intubation, or hospital admission due to sedation complications. The mean sedation doses did not differ between those with and without adverse events. No single drug or regimen had a higher adverse event rate based on age, gender, or procedure type. The overall adverse event rate was low

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Rezza Hary
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© © All Rights Reserved
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Ann Emerg Med. 1999 Oct;34(4 Pt 1):483-91.

Adverse events of procedural sedation and analgesia in a


pediatric emergency department.
Pea BM, Krauss B.

Author information

Abstract
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.

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