Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department.
OBJECTIVE
Assessment of preprocedural fasting is considered essential in minimizing the risks of procedural sedation and analgesia. Established fasting guidelines are difficult to follow in the emergency department (ED). We characterize the fasting status of patients receiving procedural sedation and analgesia in a pediatric ED and assess the relationship between fasting status and adverse events.


METHODS
A prospective case series was conducted in a children's hospital ED during an 11-month period. All consecutive patients requiring procedural sedation and analgesia were included. Preprocedural fasting state and adverse events were recorded. The percentage of patients undergoing procedural sedation and analgesia who did not meet fasting guidelines was determined. Adverse events were analyzed in relation to fasting status.


RESULTS
One thousand fourteen patients underwent procedural sedation and analgesia, and data on fasting status were available for 905 (89%) patients. Of these 905 patients, 509 (56%; 95% confidence interval [CI] 53% to 60%) did not meet fasting guidelines. Seventy-seven adverse events occurred in 68 (6.7%; 95% CI 5.2% to 8.4%) of the 1,014 patients. All adverse events were minor and successfully treated. Adverse events occurred in 32 (8.1%; 95% CI 5.6% to 11.2%) of 396 patients who met and 35 (6.9%; 95% CI 4.8% to 9.4%) of 509 patients who did not meet fasting guidelines. There was no significant difference in median fasting duration between patients with and without adverse events and between patients with and without emesis. Emesis occurred in 15 (1.5%) patients. There were no episodes of aspiration (1-sided 97.5% CI 0% to 0.4%).


CONCLUSIONS
Fifty-six percent of children undergoing ED procedural sedation and analgesia were not fasted in accordance with established guidelines. There was no association between preprocedural fasting state and adverse events.
Division of Emergency Medicine, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA. dewesh.agrawal@alumni.duke.edu
Dewesh
D
Agrawal
Shannon F
SF
Manzi
Raina
R
Gupta
Baruch
B
Krauss
D000759:Adjuvants, Anesthesia / Q000009:adverse effects; D000698:Analgesia / Q000009:adverse effects* / Q000379:methods; D019162:Anesthetics, Combined / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D002697:Chloral Hydrate / Q000009:adverse effects; D016292:Procedural Sedation / Q000009:adverse effects* / Q000379:methods; D003975:Diazepam / Q000009:adverse effects; D004638:Emergency Treatment / Q000379:methods / Q000592:standards; D005215:Fasting; D005283:Fentanyl / Q000009:adverse effects; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007022:Hypotension / Q000139:chemically induced; D000860:Hypoxia / Q000139:chemically induced; D007649:Ketamine / Q000009:adverse effects; D007826:Laryngismus / Q000139:chemically induced; D008140:Lorazepam / Q000009:adverse effects; D008874:Midazolam / Q000009:adverse effects; D009609:Nitrous Oxide / Q000009:adverse effects; D018579:Patient Selection; D010372:Pediatrics / Q000379:methods / Q000592:standards; D010424:Pentobarbital / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D014839:Vomiting / Q000139:chemically induced
D000759:Adjuvants, Anesthesia; D019162:Anesthetics, Combined; D006993:Hypnotics and Sedatives; D002697:Chloral Hydrate; D007649:Ketamine; D010424:Pentobarbital; D009609:Nitrous Oxide; D008140:Lorazepam; D003975:Diazepam; D008874:Midazolam; D005283:Fentanyl