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Pediatric Procedural Sedation: No Effect of Provider Specialty on Complication Rates

Summary and Comment |
June 17, 2011

Pediatric Procedural Sedation: No Effect of Provider Specialty on Complication Rates

  1. Katherine Bakes, MD

In a large multicenter study, complication rates did not differ by provider specialty when sedation was performed in a hospital-based pediatric procedural sedation service.

  1. Katherine Bakes, MD

To determine whether rates of major complications during pediatric procedural sedation vary by provider specialty, researchers prospectively collected data from 38 hospitals in Canada and the U.S. between 2004 and 2008. Procedures were performed in a dedicated hospital-based pediatric sedation service. Major complications were defined as aspiration, death, cardiac arrest, unplanned hospital admission or level-of-care increase, or emergency anesthesia consultation.

Among 131,751 cases of procedural sedation in children (age range, 0–18 years), there were 122 major complications and no deaths. Major complication rates per 10,000 sedations were 7.6 for anesthesiologists, 7.8 for pediatric emergency medicine physicians, 9.6 for pediatric intensivists, 12.4 for pediatricians, and 10.2 for other specialists (radiologist, surgeon, dentist, pediatric resident or fellow, advanced practice nurse, certified registered nurse anesthetist, or registered nurse). Odds ratios for major complications (relative to anesthesiologists) did not differ significantly among specialties either before or after adjustment for potential confounders.

Comment

Pediatric procedural sedation can be performed safely outside the operating room by providers in many specialties when appropriate safeguards and protocols are in place. Providers performing sedation must have the skills necessary to rescue children from a deeper level of sedation than anticipated, including advanced airway techniques; the need for emergent anesthesia consultation should be rare.

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