Pradip P Kamat1, Carmen Sulton2, Sapna R Kudchadkar3, Courtney E McCracken4, Khristopher M Nguyen5, Stephen F Simoneaux6, Michael D Mallory7, Harold K Simon2. 1. Children's Healthcare of Atlanta at Egleston, Ga (PP Kamat, C Sulton, CE McCracken, and HK Simon); Departments of Pediatrics, Division of Critical Care Medicine (PP Kamat),. Electronic address: Pradip.kamat@choa.org. 2. Children's Healthcare of Atlanta at Egleston, Ga (PP Kamat, C Sulton, CE McCracken, and HK Simon); Pediatrics and Emergency Medicine (C Sulton and HK Simon). 3. Department of Anesthesiology and Critical Care Medicine; Department of Pediatrics, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center, Baltimore, Md (SR Kudchadkar). 4. Children's Healthcare of Atlanta at Egleston, Ga (PP Kamat, C Sulton, CE McCracken, and HK Simon); Pediatrics (CE McCracken and KM Nguyen). 5. Pediatrics (CE McCracken and KM Nguyen). 6. and Pediatric Radiology and Imaging Sciences (SF Simoneaux), Emory University School of Medicine, Atlanta, Ga. 7. Pediatric Emergency Medicine Associates, Children's Healthcare of Atlanta, Ga (MD Mallory).
Abstract
OBJECTIVES: To determine the characteristics of children who met the risk criteria for potential neurotoxicity defined by the US Food and Drug Administration (FDA; 2016 warning) in a procedural sedation (PS) service. STUDY DESIGN: A single-center retrospective review of all infants and children aged <3 years receiving PS outside the operating room from 2014 to 2016. Demographics, duration of, and the reason for PS were analyzed. RESULTS: A total of 2950 patients with 3653 sedation encounters were included. Median age was 19 (range, 11-26) months. Most PS (86.4%) were for magnetic resonance imaging (MRI). The median number of sedation procedures per patient was 1 (25th-75th: 1-7), and median duration of sedation was 72 minutes (25th-75th: 55-98 minutes). Forty patients (1.4%) required prolonged sedations >3 hours, in a single encounter (median, [25th-75th] of 196 minutes [185-214 minutes]), and 298 patients (10.1%) had multiple sedation exposures during the study period. Overall, 327 patients, 11.1% (95% confidence interval, 10.0%-12.3%) required repeated and/or prolonged sedation. The most common reasons for repeated or prolonged sedation were MRI of the brain and neurologic concerns. CONCLUSIONS: Multiple and prolonged PS commonly occurs outside the operating room in this young and potentially vulnerable population. Although certain imaging cannot be avoided, other cases may have the potential to be delayed until the child is >3 years old or to have alternate imaging that may not require prolonged PS. Family and provider awareness of the FDA warnings regarding potential neurotoxicity of sedation in all settings, both inside and outside the operating room, is critical.
OBJECTIVES: To determine the characteristics of children who met the risk criteria for potential neurotoxicity defined by the US Food and Drug Administration (FDA; 2016 warning) in a procedural sedation (PS) service. STUDY DESIGN: A single-center retrospective review of all infants and children aged <3 years receiving PS outside the operating room from 2014 to 2016. Demographics, duration of, and the reason for PS were analyzed. RESULTS: A total of 2950 patients with 3653 sedation encounters were included. Median age was 19 (range, 11-26) months. Most PS (86.4%) were for magnetic resonance imaging (MRI). The median number of sedation procedures per patient was 1 (25th-75th: 1-7), and median duration of sedation was 72 minutes (25th-75th: 55-98 minutes). Forty patients (1.4%) required prolonged sedations >3 hours, in a single encounter (median, [25th-75th] of 196 minutes [185-214 minutes]), and 298 patients (10.1%) had multiple sedation exposures during the study period. Overall, 327 patients, 11.1% (95% confidence interval, 10.0%-12.3%) required repeated and/or prolonged sedation. The most common reasons for repeated or prolonged sedation were MRI of the brain and neurologic concerns. CONCLUSIONS: Multiple and prolonged PS commonly occurs outside the operating room in this young and potentially vulnerable population. Although certain imaging cannot be avoided, other cases may have the potential to be delayed until the child is >3 years old or to have alternate imaging that may not require prolonged PS. Family and provider awareness of the FDA warnings regarding potential neurotoxicity of sedation in all settings, both inside and outside the operating room, is critical.
Authors: Pradip P Kamat; Matthew T Santore; Nir Atlas; Elizabeth M Sinclair; Harold K Simon; Erica L Riedesel; Janet Figueroa Journal: Pediatr Surg Int Date: 2022-01-28 Impact factor: 1.827
Authors: Dudley E Hammon; Katharine Pearsall; Nancy M Smith; Allison S McBride; Andora L Bass; Janet A Tooze; Thomas W McLean Journal: J Pediatr Hematol Oncol Date: 2022-01-01 Impact factor: 1.170