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Independent risk factors for adverse events associated with propofol-based pediatric sedation performed by anesthesiologists in the radiology suite: a prospective observational study

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Abstract

This study aimed to identify the types and frequencies of adverse events, as well as the risk factors for respiratory complications related to pediatric sedation. This single-center, prospective, observational study was conducted in a radiology suite at a tertiary university hospital for 2 years. Patients aged under 18 years, who underwent sedation solely by anesthesiologists for computed tomography or magnetic resonance imaging scans, were eligible for inclusion. Univariate and multivariate logistic regression analyses were carried out to identify the risk factors of adverse events, including respiratory complications, related to the propofol-based sedation. We further performed a sensitivity test with 1-to-5 propensity score matching analysis to assess the robustness of our findings. Among 2569 children, 3.9% experienced respiratory problems related to the sedation. After 1-to-5 propensity matching analysis, cardiac and neurologic comorbidities, crying before sedation, a history of snoring or upper respiratory infection, and prolonged duration of sedation were independently associated with the occurrence of adverse respiratory events.

Conclusions: Our protocol for pediatric sedation demonstrates a high success rate and low likelihood of fatal complications, but proactive management prior to propofol-based sedation is critical to prevent adverse respiratory events in children.

What is Known:

• Propofol-based pediatric sedation is associated with adverse events necessarily even though performed by professional anesthesiologists solely.

What is New:

• Cardiac and neurologic comorbidities, crying before sedation, a history of snoring or upper respiratory infection, and prolonged duration of sedation were independently associated with the occurrence of respiratory adverse events.

• Proactive management prior to sedation is critical to preventing adverse respiratory events for pediatrics.

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Data availability

We provided our data as an electronic supplemental material.

Abbreviations

ASA:

American Society of Anesthesiologists

CIs:

Confidence intervals

CT:

Computed tomography

ICU:

Intensive care unit

LMA:

Laryngeal mask airway

MRI:

Magnetic resonance imaging

NPO:

Nil per os

OR:

Odds ratio

PSAU:

Pediatric Sedation and Anesthesia Unit

UMSS:

University of Michigan Sedation Scale

URI:

Upper respiratory infection

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Jeong-Rim Lee, Jae Hoon Lee & Hye-Mi Lee

  2. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea

    Nayeon Kim

  3. Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea

    Myoung Hwa Kim

Authors
  1. Jeong-Rim Lee
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  2. Jae Hoon Lee
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Contributions

JRL contributed to conceive study design, acquire and interpret study data, draft the manuscript, and revise the manuscript critically for important intellectual content. JHL conceived the study and drafted the manuscript. HML acquired study data. NK interpreted study data. MHK substantially contributed to conceive study design; acquire, analyze, and interpret study data; draft the manuscript; and revise the manuscript critically for important intellectual content. All authors approved final version to be published and agreed to be accountable for all aspects of the work, thereby ensured that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.

Corresponding author

Correspondence to Myoung Hwa Kim.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Our study was approved by the Institute Research Committee of Severance Hospital, Yonsei University Health System (IRB number: 4-2012-0688) and registered at clinicaltrials.gov (NCT01855555).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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Additional information

Communicated by Peter de Winter

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Lee, JR., Lee, J.H., Lee, HM. et al. Independent risk factors for adverse events associated with propofol-based pediatric sedation performed by anesthesiologists in the radiology suite: a prospective observational study. Eur J Pediatr 180, 1413–1422 (2021). https://doi.org/10.1007/s00431-020-03916-w

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  • DOI: https://doi.org/10.1007/s00431-020-03916-w

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