title: Sedation and Anesthesia in Pediatric and Congenital Cardiac Catheterization: A Prospective Multicenter Experience.
abstract: Sedation/anesthesia is critical to cardiac catheterization in the pediatric/congenital heart patient. We sought to identify current sedation/anesthesia practices, the serious adverse event rate related to airway, sedation, or anesthesia, and the rate of intra-procedural conversion from procedural sedation to the use of assisted ventilation or an artificial airway. Data from 13,611 patients who underwent catheterization at eight institutions were prospectively collected from 2007 to 2010. Ninety-four (0.69 %) serious sedation/airway-related adverse events occurred; events were more likely to occur in smaller patients (<4 kg, OR 4.4, 95 % CI 2.3-8.2, p < 0.001), patients with non-cardiac comorbidities (OR 1.7, 95 % CI 1.1-26, p < 0.01), and patients with low mixed venous oxygen saturation (OR 2.3, 95 % CI 1.4-3.6, p < 0.001). Nine thousand three hundred and seventy-nine (69 %) patients were initially managed with general endotracheal anesthesia, LMA, or tracheostomy, whereas 4232 (31 %) were managed with procedural sedation without an artificial airway, of which 75 (1.77 %) patients were converted to assisted ventilation/general anesthesia. Young age (<12 months, OR 5.2, 95 % CI 2.3-11.4, p < 0.001), higher-risk procedure (category 4, OR 10.1, 95 % CI 6.5-15.6, p < 0.001), and continuous pressor/inotrope requirement (OR 11.0, 95 % CI 8.6-14.0, p < 0.001) were independently associated with conversion. Cardiac catheterization in pediatric/congenital patients was associated with a low rate of serious sedation/airway-related adverse events. Smaller patients with non-cardiac comorbidities or low mixed venous oxygen saturation may be at higher risk. Patients under 1 year of age, undergoing high-risk procedures, or requiring continuous pressor/inotrope support may be at higher risk of requiring conversion from procedural sedation to assisted ventilation/general anesthesia.
authors.affiliation: Methodist DeBakey Heart and Vascular Center, 6550 Fannin St, Smith Tower, Suite 1901, Houston, TX, 77030, USA. clin@tmhs.org.
authors.forename: C Huie
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Sanyukta
authors.initials: S
authors.lastname: Desai
authors.affiliation: St. Louis Children's Hospital, St. Louis, MO, USA.
authors.forename: Ramzi
authors.initials: R
authors.lastname: Nicolas
authors.affiliation: Children's Hospital Boston, Boston, MA, USA.
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.affiliation: Children's Hospital of Wisconsin, Milwaukee, WI, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Foerster
authors.affiliation: St. Louis Children's Hospital, St. Louis, MO, USA.
authors.forename: Anshuman
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Oregon Health Sciences University, Portland, OR, USA.
authors.forename: Laurie
authors.initials: L
authors.lastname: Armsby
authors.affiliation: Children's Hospital Boston, Boston, MA, USA.
authors.forename: Audrey C
authors.initials: AC
authors.lastname: Marshall
authors.affiliation: Children's Hospital Boston, Boston, MA, USA.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Odegard
authors.affiliation: Children's Hospital Boston, Boston, MA, USA.
authors.forename: James
authors.initials: J
authors.lastname: DiNardo
authors.affiliation: Morgan Stanley Children's Hospital, New York, NY, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Vincent
authors.affiliation: Rady Children's Hospital, San Diego, CA, USA.
authors.forename: Howaida
authors.initials: H
authors.lastname: El-Said
authors.affiliation: Cincinnati Children's Hospital, Cincinnati, OH, USA.
authors.forename: James
authors.initials: J
authors.lastname: Spaeth
authors.affiliation: Cincinnati Children's Hospital, Cincinnati, OH, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Goldstein
authors.affiliation: Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Ralf
authors.initials: R
authors.lastname: Holzer
authors.affiliation: Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jackie
authors.initials: J
authors.lastname: Kreutzer
authors.affiliation: St. Louis Children's Hospital, St. Louis, MO, USA.
authors.forename: David
authors.initials: D
authors.lastname: Balzer
authors.affiliation: Children's Hospital Boston, Boston, MA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bergersen
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General / Q000009:adverse effects*; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000009:adverse effects*; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D010372:Pediatrics; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: Anesthesia; Angioplasty; Catheterization; Congenital; Heart defects; Pediatrics