title: Outcomes following implementation of a pediatric procedural sedation guide for referral to general anesthesia for magnetic resonance imaging studies.
abstract: Guidelines for referral of children to general anesthesia (GA) to complete MRI studies are lacking. We devised a pediatric procedural sedation guide to determine whether a pediatric procedural sedation guide would decrease serious adverse events and decrease failed sedations requiring rescheduling with GA.
  
  
  
  We constructed a consensus-based sedation guide by combining a retrospective review of reasons for referral of children to GA (n = 221) with published risk factors associated with the inability to complete the MRI study with sedation. An interrupted time series analysis of 11 530 local sedation records from the Pediatric Sedation Research Consortium between July 2008 and March 2013, adjusted for case-mix differences in the pre- and postsedation guide cohorts, evaluated whether a sedation guide resulted in decreased severe adverse events (SAE) and failed sedation rates.
  
  
  
  A significant increase in referrals to GA following implementation of a sedation guide occurred (P < 0.001), and fewer children with an ASA-PS class ≥III were sedated using procedural sedation (P < 0.001). There was no decrease in SAE (P = 0.874) or in SAE plus airway obstruction with concurrent hypoxia (P = 0.435). There was no change in the percentage of failed sedations (P = 0.169).
  
  
  
  More studies are needed to determine the impact of a sedation guide on pediatric procedural sedation services.
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.
authors.forename: Jocelyn R
authors.initials: JR
authors.lastname: Grunwell
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Neelima K
authors.initials: NK
authors.lastname: Marupudi
authors.affiliation: Department of Medicine, Mercer University School of Medicine, Macon, GA, USA.
authors.forename: Rohan V
authors.initials: RV
authors.lastname: Gupta
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Curtis D
authors.initials: CD
authors.lastname: Travers
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Courtney E
authors.initials: CE
authors.lastname: McCracken
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.|Department of Anesthesia, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Williamson
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.
authors.forename: Jana A
authors.initials: JA
authors.lastname: Stockwell
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Fortenberry
authors.affiliation: Pediatric Sedation Services, Yale School of Medicine and Yale New Haven Children's Hospital, New Haven, CT, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Couloures
authors.affiliation: Department of Anesthesia, Harvard School of Medicine and Boston Children's Hospital, Boston, MA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cravero
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.
authors.forename: Pradip P
authors.initials: PP
authors.lastname: Kamat
mesh_terms: D000768:Anesthesia, General / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: adverse events; airway obstruction; laryngospasm; pediatric; procedural sedation; propofol