title: Procedural sedation for diagnostic imaging in children by pediatric hospitalists using propofol: analysis of the nature, frequency, and predictors of adverse events and interventions.
abstract: OBJECTIVE
  To evaluate the nature, frequency, and predictors of adverse events during the use of propofol by pediatric hospitalists.
  
  
  METHODS
  We reviewed 1649 charts of patients sedated with propofol by pediatric hospitalists at St Louis Children's Hospital between January 2005 and September 2009.
  
  
  RESULTS
  Hospitalists were able to complete 1633 of the 1649 sedations reviewed (99%). Major complications included 2 patients with aspiration and 1 patient intubated to complete the study. We observed a 74% reduction in the number of patients with respiratory events and airway interventions from 2005 to 2009. Predictors of respiratory events were history of snoring (OR, 2.40; 95% CI, 1.52-3.80), American Society of Anesthesiologists (ASA) physical status classification of ASA 3 (OR, 2.30; 95% CI, 1.22-4.33), age >12 years (OR, 4.01; 95% CI, 2.02-7.98), premedication with midazolam (OR, 1.85; 95% CI, 1.15-2.98), and use of adjuvant glycopyrrolate (OR, 4.70; 95% CI, 2.35-9.40). All except ASA 3 status were also predictors for airway intervention. There was a decline in the prevalence of all of these predictors over the study years (P < .05) except for use of glycopyrrolate.
  
  
  CONCLUSIONS
  Our pediatric hospitalists implemented a successful propofol sedation program that realized a 74% reduction in respiratory events and airway interventions between 2005 and 2009. Decreased prevalence of the predictors of adverse events that we identified likely contributed to this reduction.
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA. srinivasan_m@kids.wustl.edu
authors.forename: Mythili
authors.initials: M
authors.lastname: Srinivasan
authors.forename: Michael
authors.initials: M
authors.lastname: Turmelle
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Depalma
authors.forename: Jingnan
authors.initials: J
authors.lastname: Mao
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Carlson
mesh_terms: D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D016292:Procedural Sedation / Q000009:adverse effects* / Q000379:methods; D003952:Diagnostic Imaging; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol