Safety of deep sedation in young children with sickle cell disease: a retrospective cohort study.
OBJECTIVE
To assess the rates and types of complications associated with deep sedation in children with sickle cell disease (SCD) and to explore potential risk factors.


METHODS
This was a retrospective cohort study of children with SCD and a comparison group of children without SCD who underwent magnetic resonance imaging with deep sedation. The rates of general and SCD-associated sedation complications were calculated, and potential associated clinical and laboratory variables were assessed.


RESULTS
A total of 162 sedation records in 94 subjects with SCD and 324 sedation records in 321 subjects without SCD were assessed (mean age, 4.3 years in both groups). Pentobarbital, fentanyl, and midazolam were used in the majority of sedation episodes without routine presedation transfusion. Sedation-related complication rates did not differ significantly between the SCD and comparison groups. Within 1 month after the sedation procedure, 17 children (10%) experienced a vaso-occlusive pain episode (VOE), and 2 children (1.2%) developed acute chest syndrome. Preprocedure and postprocedure rates of these complications did not differ significantly. Subjects who developed VOE after sedation had a significantly higher VOE rate before sedation, but no other significant clinical or laboratory risk factors were identified.


CONCLUSIONS
Deep sedation in young children with SCD using a standard protocol is safe, with a sedation-related complication rate comparable to that of the general pediatric population. The observed rate of VOE, although not significantly higher than expected, warrants further investigation.
Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA.
Ami P
AP
Belmont
Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA.
Fadi
F
Nossair
RTI International, Rockville, MD.
Donald
D
Brambilla
Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA.
Marjorie
M
Friedman
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Jan
J
Boswinkel
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Andrea B
AB
Bradford
Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address: kwiatkowski@email.chop.edu.
Janet L
JL
Kwiatkowski
D056586:Acute Chest Syndrome / Q000209:etiology*; D000759:Adjuvants, Anesthesia / Q000009:adverse effects; D000755:Anemia, Sickle Cell / Q000150:complications / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D054810:Deep Sedation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008874:Midazolam / Q000009:adverse effects; D010146:Pain / Q000209:etiology*; D061214:Patient Safety; D010424:Pentobarbital / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors
D000759:Adjuvants, Anesthesia; D010424:Pentobarbital; D008874:Midazolam; D005283:Fentanyl