title: Adverse events of conscious sedation in ambulatory spine procedures.
abstract: BACKGROUND
  Interventional spine procedures are commonly performed in the ambulatory surgical setting, often using conscious sedation. The rate of adverse events with conscious sedation has not been previously assessed in the interventional spine procedure setting.
  
  
  OBJECTIVE
  The goal of this study was to determine the rate of adverse events when using conscious sedation in the ambulatory interventional spine setting.
  
  
  METHODS
  A retrospective cohort chart review analysis was performed on all interventional spine procedures performed during one calendar year at a university-affiliated ambulatory surgery center by six nonanesthesia-trained spine interventionalists.
  
  
  METHODS
  Of the 3,342 procedures performed that year, 2,494 charts (74.6%) were available for review.
  
  
  METHODS
  Adverse events were documented immediately after the procedure and at a maximum 3-day follow-up phone call.
  
  
  METHODS
  The rate and type of adverse events were analyzed and compared between those who received conscious sedation with local anesthesia and those who received local anesthesia alone.
  
  
  RESULTS
  Of the 2,494 cases reviewed, 1,228 spine procedures were performed with local anesthesia and conscious sedation, and 1,266 procedures were performed with local anesthesia alone. Of these cases, 66 immediate adverse events (5.12%) were documented in the conscious sedation group, and 61 immediate adverse events (4.82%) were documented in the local anesthesia alone group. At maximum 3-day follow-up, 670 patients of the conscious sedation group were available for contact, and 699 patients were available from the local anesthesia group. Thirty-two adverse events (4.77%) were noted in the conscious sedation group, and 28 adverse events (4.00%) were noted in the local anesthesia group. Comparison of these rates found no significant statistical difference. However, patients in the local anesthesia group had a significantly higher rate of postoperative hypertension. Adverse events reported both immediately and at follow-up were determined to be mild, with no serious adverse events reported.
  
  
  CONCLUSIONS
  The findings of this study suggest that mild to moderate conscious sedation in interventional spine procedures is associated with low rates of adverse events when established protocols are followed.
authors.affiliation: Emory Orthopaedics & Spine Center, Emory Healthcare, 59 Executive Park South, Atlanta, GA 30329, USA. mschauf@emory.edu
authors.forename: Michael K
authors.initials: MK
authors.lastname: Schaufele
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Marín
authors.forename: Jordan L
authors.initials: JL
authors.lastname: Tate
authors.forename: Adam C
authors.initials: AC
authors.lastname: Simmons
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D000772:Anesthesia, Local; D002045:Bupivacaine / Q000009:adverse effects; D016292:Procedural Sedation / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl; D055991:Health Records, Personal; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D008012:Lidocaine; D008874:Midazolam; D005283:Fentanyl; D002045:Bupivacaine