title: Desaturation in procedural sedation for children with long bone fractures: Does weight status matter?
abstract: BACKGROUND
  Childhood obesity remains a serious problem in the United States. Significant associated adverse incidents have been reported with sedation of children with obesity, namely hypoxemia. The objective of our study was to determine if overweight and obesity were associated with increased desaturations during procedural sedation compared with patients of healthy weight.
  
  
  METHODS
  This was a single-center retrospective chart review of data from a three-year period of patient's age 2-17years. Of the 1700 charts reviewed 823 of these patients received procedural sedation and met the study inclusion criteria. Weight status was classified based on age and gender specific body mass index (BMI) percentiles: underweight, healthy weight, overweight, obese.
  
  
  RESULTS
  Among all weight categories there was no statistical significance, however children with obesity had greater desaturation rates (9.9%) compared with children of underweight, healthy weight, or overweight combined (5.4%), χ2=4.46, p=0.035.
  
  
  CONCLUSIONS
  The results indicate that children with obesity are almost twice as likely to have a desaturation related to procedural sedation compared with children of other weight status. Providers should be aware that children with obesity may be more likely to desaturate than other children, and therefore be skilled at recognizing this.
authors.affiliation: Women and Children's Hospital of Buffalo, University Pediatric Associates, Division of Pediatric Emergency Medicine, 219 Bryant Street, Buffalo, NY 14222, USA; Women and Children's Hospital of Buffalo, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 3435 Main Street, Buffalo, NY 14214, USA. Electronic address: hirsch-danielle@cooperhealth.edu.
authors.forename: Danielle G
authors.initials: DG
authors.lastname: Hirsch
authors.affiliation: Women and Children's Hospital of Buffalo, University Pediatric Associates, Division of Pediatric Emergency Medicine, 219 Bryant Street, Buffalo, NY 14222, USA; Women and Children's Hospital of Buffalo, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 3435 Main Street, Buffalo, NY 14214, USA.
authors.forename: John
authors.initials: J
authors.lastname: Tyo
authors.affiliation: Women and Children's Hospital of Buffalo, University Pediatric Associates, Division of Pediatric Emergency Medicine, 219 Bryant Street, Buffalo, NY 14222, USA; Women and Children's Hospital of Buffalo, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 3435 Main Street, Buffalo, NY 14214, USA.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Wrotniak
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D015992:Body Mass Index; D019296:Capnography / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D000860:Hypoxia / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D063766:Pediatric Obesity / Q000150:complications / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D014481:United States
keywords: Bone fracture; Obesity; Pediatrics; Sedation