title: Comparison of adverse events during procedural sedation between specially trained pediatric residents and pediatric emergency physicians in Israel.
abstract: OBJECTIVE
  The aim was to compare the rate of procedural sedation-related adverse events of pediatric residents with specific training in "patient safety during sedation" and pediatric emergency physicians (PEPs) who completed the same course or were teaching faculty for it.
  
  
  METHODS
  This prospective single-blinded, nonrandomized study was conducted in two university-affiliated pediatric emergency departments (PEDs) in Israel. Pediatric residents who were authorized to perform unsupervised sedations had previously completed a course in patient safety during sedation. Unsupervised sedations by residents were defined as sedations where the entire procedure was performed independently. Study subjects had autonomy in choosing medications for sedation. Adverse events were defined as transient hypoxia (oxygen saturation < or = 90%) or apnea. Adverse outcomes were situations where intubation or hospitalization directly related to sedation complications would occur. Sedations over 12 consecutive months were recorded, and rates of adverse events in each group were compared.
  
  
  RESULTS
  A total of 984 eligible sedations were recorded, 635 by unsupervised residents and 349 by PEPs. A total of 512 (80.6%) sedations were performed by residents when attending physicians were not in the ED. The total adverse event rate was 24/984 (2.44%). When the two groups used a similar type drugs, residents had 8/635 (1.26%) events, compared to 11/328 (3.35%) by PEPs. There was no statistically significant difference in the rates of hypoxia or apnea between the two groups (p = 0.29 and p = 0.18, respectively). Adverse outcomes did not occur.
  
  
  CONCLUSIONS
  Unsupervised pediatric residents with training in patient safety during sedation performed procedural sedations with a rate of adverse events similar to that of PEPs.
authors.affiliation: Emergency Department, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel. i_shavit@rambam.health.gov.il
authors.forename: Itai
authors.initials: I
authors.lastname: Shavit
authors.forename: Ivan P
authors.initials: IP
authors.lastname: Steiner
authors.forename: Sigalit
authors.initials: S
authors.lastname: Idelman
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mosleh
authors.forename: Amir
authors.initials: A
authors.lastname: Hadash
authors.forename: Lilach
authors.initials: L
authors.lastname: Biniamini
authors.forename: Mirit
authors.initials: M
authors.lastname: Lezinger
authors.forename: Eran
authors.initials: E
authors.lastname: Kozer
mesh_terms: D000698:Analgesia / Q000009:adverse effects / Q000592:standards*; D000776:Anesthesiology / Q000193:education*; D016009:Chi-Square Distribution; D016292:Procedural Sedation / Q000009:adverse effects / Q000592:standards*; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007396:Internship and Residency; D007557:Israel; D010372:Pediatrics / Q000193:education*; D011446:Prospective Studies; D016037:Single-Blind Method
chemical_list: D006993:Hypnotics and Sedatives