Outcomes following implementation of a pediatric procedural sedation guide for referral to general anesthesia for magnetic resonance imaging studies

• Type of Material: Article
• Authors: Jocelyn Grunwell, Emory University; Neelima K. Marupudi, Emory University; Rohan V. Gupta, Mercer University; Curtis D. Travers, Emory University; Courtney E. McCracken, Emory University; Julie Williamson, Emory University; Jana Stockwell, Emory University; James Fortenberry, Emory University; Kevin Couloures, Yale University; Joseph Cravero, Harvard University; Pradip Kamat, Emory University
• Language: English
• Date: 2016-04-07
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 John Wiley & Sons Ltd. This is the peer reviewed version of the following article, which has been published in final form. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
• Final Published Version (URL): http://dx.doi.org/10.1111/pan.12903
• Title of Journal or Parent Work: Pediatric Anesthesia
• ISSN: 1155-5645
• Volume: 26
• Issue: 6
• Start Page: 628
• End Page: 636
• Grant/Funding Information: The study received no external funding.
• Keywords: propofol; Science & Technology; RESEARCH CONSORTIUM; airway obstruction; Pediatrics; adverse events; THERAPEUTIC PROCEDURES; ADVERSE EVENTS; procedural sedation; Anesthesiology; PROPOFOL SEDATION; pediatric; RISK; IMPACT; laryngospasm; OPERATING-ROOM; Life Sciences & Biomedicine; EXPERIENCE; SEDATION/ANESTHESIA; CHILDREN
• Research Categories: Health Sciences, Human Development; Health Sciences, General

Abstract

Background/Aims: Guidelines for referral of children to general anesthesia (GA) to complete MRI studies are lacking. We devised a pediatric procedural sedation guide to determine whether a pediatric procedural sedation guide would decrease serious adverse events and decrease failed sedations requiring rescheduling with GA. Methods: We constructed a consensus-based sedation guide by combining a retrospective review of reasons for referral of children to GA (n = 221) with published risk factors associated with the inability to complete the MRI study with sedation. An interrupted time series analysis of 11 530 local sedation records from the Pediatric Sedation Research Consortium between July 2008 and March 2013, adjusted for case-mix differences in the pre- and postsedation guide cohorts, evaluated whether a sedation guide resulted in decreased severe adverse events (SAE) and failed sedation rates. Results: A significant increase in referrals to GA following implementation of a sedation guide occurred (P < 0.001), and fewer children with an ASA-PS class ≥III were sedated using procedural sedation (P < 0.001). There was no decrease in SAE (P = 0.874) or in SAE plus airway obstruction with concurrent hypoxia (P = 0.435). There was no change in the percentage of failed sedations (P = 0.169). Conclusions: More studies are needed to determine the impact of a sedation guide on pediatric procedural sedation services.