title: Prevalence and Predictors of Adverse Events during Procedural Sedation Anesthesia-Outside the Operating Room for Esophagogastroduodenoscopy and Colonoscopy in Children: Age Is an Independent Predictor of Outcomes.
abstract: OBJECTIVE
  Procedural sedation/anesthesia outside the operating room for a variety of procedures is well described with an overall low adverse event rate in certain settings. Adverse event associated with procedural sedation/anesthesia outside the operating room for gastrointestinal procedures have been described, albeit in small, single-center studies with wide variance in outcomes. Predictors of such outcomes are unclear. We aimed to estimate the prevalence of adverse event in children undergoing procedural sedation/anesthesia outside the operating room for esophagogastroduodenoscopy, colonoscopy, or both to identify predictors of adverse event.
  
  
  METHODS
  Retrospective analysis of Pediatric Sedation Research Consortium database, a large data repository of pediatric patients aged 21 years old or younger undergoing procedural sedation/anesthesia outside the operating room during September 2007 to November 2011. Twenty-two of the 40 centers provided data pertaining to the procedure of interest.
  
  
  METHODS
  None.
  
  
  RESULTS
  Primary outcome variable is any adverse event. Independent variables include: age (five groups), sex, American Societyof Anaesthesiologists status, procedure (esophagogastroduodenoscopy, colonoscopy, or both), provider responsible, medication used, location, and presence of coexisting medical conditions. Descriptive statistics used to summarize the data. Using multivariablelogistic regression model, odds ratio, 95% CI) were computed. A total of 12,030 procedures were performed (esophagogastroduodenoscopy, 7,970; colonoscopy, 1,378; and both, 2,682). A total of 96.9% of patients received propofol. Eighty-three percent were performed in a sedation unit. Prevalence of adverse event was 4.8%. The most common adverse event were persistent desaturations (1.5%), airway obstruction (1%), cough (0.9%), and laryngospasm (0.6%). No deaths or CPR occurred. Infants and children aged 5 years old or younger had a higher adverse event rate than older children (15.8%, 7.8% vs 4%). Regression analysis revealed age 5 years old or younger, American Society of Anaesthesiologists greater than or equal to 2, esophagogastroduodenoscopy ± colonoscopy, and coexisting medical conditions of obesity and lower airway disease were independent predictors of higher adverse event.
  
  
  CONCLUSIONS
  Overall prevalence of any adverse event was 4.8%. Independent predictors of adverse events in procedural sedation/anesthesia outside the operating room in pediatric esophagogastroduodenoscopy/colonoscopy onoscopy were identified. Recognition of such risk factors may enable optimization of procedural sedation.
authors.affiliation: 1Department of Pediatric Critical Care Medicine, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH. 2Department of Orthodontics, School of Dental Medicine, University of Iowa, Iowa City, IA. 3Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH. 4Department of Pediatric Critical Care Medicine, Yale New Haven Hospital, Yale University, New Haven, CT. 5Children's Hospital Boston, Harvard University, Cambridge, MA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Biber
authors.forename: Veerajalandhar
authors.initials: V
authors.lastname: Allareddy
authors.forename: Veerasathpurush
authors.initials: V
authors.lastname: Allareddy
authors.forename: Susan M
authors.initials: SM
authors.lastname: Gallagher
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Couloures
authors.forename: David G
authors.initials: DG
authors.lastname: Speicher
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Cravero
authors.forename: Anne G
authors.initials: AG
authors.lastname: Stormorken
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000758:Anesthesia / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003113:Colonoscopy / Q000706:statistics & numerical data*; D016145:Endoscopy, Digestive System / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012737:Sex Factors; D055815:Young Adult