Adverse cardiovascular and respiratory events during sedation of pediatric patients for imaging examinations.
OBJECTIVE
To retrospectively identify factors associated with an increased risk of adverse cardiovascular or respiratory events during sedation of pediatric patients for imaging examinations.


METHODS
This HIPAA-compliant study was institutional review board approved; the requirement for informed consent was waived. All sedation information--including patient demographics, medications (doses and routes of administration), time required to sedate and before discharge, American Society of Anesthesiologists physical status classification, adverse events, and failed sedations--was maintained in a computerized database. A review of the data on all patients sedated between 1997 and 2003 for magnetic resonance imaging, computed tomography, and interventional radiology revealed associated adverse respiratory events in 70 patients. Adverse respiratory event was defined as oxygen desaturation of at least 5%, pulmonary aspiration, and need for airway resuscitation. Adverse cardiovascular events were defined as cardiac arrest and hemodynamic changes requiring medical therapy. Adverse events were compared between sedation regimens--which included fentanyl, chloral hydrate, pentobarbital, and midazolam hydrochloride--by using the Fisher exact test. Multiple logistic regression analysis was applied to identify potential predictors of adverse events.


RESULTS
Among 16,467 sedations performed, 70 (0.4%) were associated with adverse respiratory events: 58 cases of oxygen desaturation, two pulmonary aspirations, 10 cases of airway resuscitation, and no cardiovascular events. Nearly 30% (n = 20) of the 70 patients who had an adverse event had a history of serious respiratory illness. Logistic regression analysis revealed that neither patient age, weight, or sex nor type of imaging procedure was associated with an increased risk of an adverse event. Use of a single sedation agent was associated with lower adverse event risk than was use of multiple agents (P < .001).


CONCLUSIONS
Consideration should be given to using single agents, avoiding the use of multidrug sedation regimens, and recognizing that a history of pulmonary disease could be associated with an increased risk of adverse respiratory events despite a currently stable respiratory state.
Sanborn
Pamela A
PA
Department of Radiology, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
Michna
Edward
E
Zurakowski
David
D
Burrows
Patricia E
PE
Fontaine
Paulette J
PJ
Connor
Linda
L
Mason
Keira P
KP
D002319:Cardiovascular System / Q000187:drug effects*; D002675:Child, Preschool; D002697:Chloral Hydrate / Q000009:adverse effects; D016292:Procedural Sedation / Q000009:adverse effects*; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D016015:Logistic Models; D008171:Lung Diseases / Q000150:complications; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008874:Midazolam / Q000009:adverse effects; D010424:Pentobarbital / Q000009:adverse effects; D015641:Radiography, Interventional / Q000379:methods; D012119:Respiration / Q000187:drug effects*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods
D002697:Chloral Hydrate; D010424:Pentobarbital; D008874:Midazolam; D005283:Fentanyl