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PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1204-1208

Sleep Deprivation for Pediatric Sedated Procedures: Not Worth the Effort

Cynthia H. Shields, MD*, Sandi Johnson, RN{ddagger}, Jeffery Knoll, PNP{ddagger}, Cathy Chess, PNP{ddagger}, David Goldberg, MD{ddagger} and Kevin Creamer, MD{ddagger}

* Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
{ddagger} Department of Pediatrics, Walter Reed Army Medical Center, Washington, DC

Objective. Sleep deprivation is commonly used to enhance the effectiveness of pediatric sedation and to decrease sedation failures. We reviewed our sedation database to evaluate the efficacy of sleep deprivation.

Methods. The entire pediatric sedation unit database (n = 5640) was reviewed retrospectively. Patients without complete data sets were excluded. The remaining patients were separated into 2 groups: 3272 patients who underwent noninvasive procedures and 1210 who underwent invasive procedures. A subgroup of noninvasive procedure patients <2 years old (n = 1398) was also analyzed. The sedation failure rate (%) and nursing care hours for both sleep-deprived and non-sleep-deprived patients were analyzed.

Results. In the noninvasive procedure group, the sedation failure rate was 5.7% for the sleep-deprived patients and 5.6% for the non-sleep-deprived patients, whereas the sedation failure rate for children <2 years old was 4.2% for sleep-deprived patients and 4.7% for non-sleep-deprived patients. The sedation failure rate in the invasive procedure group was 7.5% for sleep-deprived patients and 7.2% for non-sleep-deprived patients. Nursing care hours in the noninvasive procedure group were significantly longer for the sleep-deprived patients (4.5 ± 1.6 hours) versus the non-sleep-deprived patients (3.8 ± 1.6 hours). This finding was true also for the subgroup of children <2 years old (sleep-deprived patients: 4.2 ± 1.4 hours; non-sleep-deprived patients: 3.5 ± 1.4 hours). No difference was noted in nursing care hours for the invasive procedure group.

Conclusions. Sleep deprivation had no effect in reducing the pediatric sedation failure rate. The patients having noninvasive procedures who were sleep deprived required significantly more nursing care hours than their non-sleep-deprived counterparts. Routine use of sleep deprivation for pediatric sedation should be critically reevaluated.

Key Words: sleep deprivation • pediatric sedation • sedation failure

Abbreviations: EEG, electroencephalography • MRI, magnetic resonance imaging • CT, computed tomography

Received for publication Jan 31, 2003; Accepted Jul 28, 2003.




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