Published online September 1, 2006
PEDIATRICS Vol. 118 No. 3 September 2006, pp. 1087-1096 (doi:10.1542/peds.2006-0313)

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ARTICLE

Incidence and Nature of Adverse Events During Pediatric Sedation/Anesthesia for Procedures Outside the Operating Room: Report From the Pediatric Sedation Research Consortium

Joseph P. Cravero, MD^a,b, George T. Blike, MD^a, Michael Beach, MD^a, Susan M. Gallagher, BS^c, James H. Hertzog, MD^d, Jeana E. Havidich, MD^e, Barry Gelman, MD^f and the Pediatric Sedation Research Consortium

^a Anesthesiology
^b Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
^c Bioinformatics Group, Dartmouth College, Hanover, New Hampsire;
^d Department of Pediatrics, Division of Critical Care, Alfred I. duPont Hospital for Children, Wilmington, Delaware
^e Department of Anesthesiology, Medical University of South Carolina, Columbia, South Carolina
^f Department of Pediatrics, Division of Critical Care, University of Miami School of Medicine, Miami, Florida

OBJECTIVE. We sought to use a large database of prospectively collected data on pediatric sedation and/or anesthesia for diagnostic and therapeutic procedures to delineate the nature and the frequency of adverse events that are associated with sedation/anesthesia care for procedures that are performed outside the operating room in children.

METHODS. Data were collected by the Pediatric Sedation Research Consortium, a collaborative group of 35 institutions that are dedicated to improving sedation/anesthesia care for children internationally. Members prospectively enrolled consecutive patients who were receiving sedation or anesthesia for procedures. Data on demographics, primary illness, coexisting illness, procedure performed, medications used, outcomes, airway interventions, and adverse events were collected and reported on a Web-based data collection tool.

RESULTS. A total of 26 institutions submitted data on 30037 sedation/anesthesia encounters during the study period from July 1, 2004, to November 15, 2005. Serious adverse events were rare in the institutions involved in this study; there were no deaths. Cardiopulmonary resuscitation was required once. Less serious events were more common with O₂ desaturation below 90% for >30 seconds, occurring 157 times per 10000 sedations. Stridor and laryngospasm both occurred in 4.3 per 10000 sedations. Unexpected apnea, excessive secretions, and vomiting had frequencies of 24, 41.6, and 47.2 per 10000 encounters, respectively.

CONCLUSIONS. Our data indicate that pediatric sedation/anesthesia for procedures outside the operating room is unlikely to yield serious adverse outcomes in a collection of institutions with highly motivated and organized sedation services. However, the safety of this practice depends on the systems' ability to manage less serious events.

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Key Words: pediatric sedation • adverse events • complications

Abbreviations: AAP—American Academy of Pediatrics • PSRC—Pediatric Sedation Research Consortium • ASA—American Society of Anesthesiologists • NPO—nil per os • CPR—cardiopulmonary resuscitation

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Accepted Apr 17, 2006.

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