Skip to main content

Adverse Events: Risk Factors, Predictors, and Outcomes

  • Chapter
  • First Online:
Pediatric Sedation Outside of the Operating Room

Abstract

The provision of sedation during therapeutic and diagnostic procedures in children is not without risk. Adverse events occur due to the interplay of patient, procedural, environmental, and medication characteristics. Preemptive recognition of the characteristics that may increase the risk of developing adverse events allows the practitioner to predict and prepare for such events. Early recognition can allow alteration to the sedation plan minimizing adverse events. Hence, timely recognition and effective management of adverse events are essential for successful outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Teshome G, Belani K, Braun JL, Constantine DR, Gattu RK, Lichenstein R. Comparison of dexmedetomidine with pentobarbital for pediatric MRI sedation. Hosp Pediatr. 2014;4(6):360–5. https://doi.org/10.1542/hpeds.2013-0111.

    Article  PubMed  Google Scholar 

  2. Fong CY, Tay CG, Ong LC, Lai NM. Chloral hydrate as a sedating agent for neurodiagnostic procedures in children. Cochrane Database Syst Rev. 2017;11:CD011786. https://doi.org/10.1002/14651858.CD011786.pub2.

    Article  PubMed  Google Scholar 

  3. Yuen VM, Li BL, Cheuk DK, Leung MKM, Hui TWC, Wong IC, et al. A randomised controlled trial of oral chloral hydrate vs. intranasal dexmedetomidine before computerised tomography in children. Anaesthesia. 2017;72(10):1191–5. https://doi.org/10.1111/anae.13981.

    Article  CAS  PubMed  Google Scholar 

  4. Cao Q, Lin Y, Xie Z, Shen W, Chen Y, Gan X, et al. Comparison of sedation by intranasal dexmedetomidine and oral chloral hydrate for pediatric ophthalmic examination. Paediatr Anaesth. 2017;27(6):629–36. https://doi.org/10.1111/pan.13148.

    Article  PubMed  Google Scholar 

  5. Cote CJ, Notterman DA, Karl HW, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics. 2000;105(4 Pt 1):805–14.

    Article  CAS  Google Scholar 

  6. Connecticut Board of Examiners for Nursing. Available from: https://portal.ct.gov/-/media/Departments-and-Agencies/DPH/dph/phho/Nursing_Board/Guidelines/PROPOFOLGUIDANCEpdf.pdf?la=n.

  7. Laituri CA, Garey CL, Pieters BJ, Mestad P, Weissend EE, Peter SD. Overnight observation in former premature infants undergoing inguinal hernia repair. J Pediatr Surg. 2012;47(1):217–20. https://doi.org/10.1016/j.jpedsurg.2011.10.045.

    Article  PubMed  Google Scholar 

  8. Scherrer PD, Rogers AP, Kamat PP. Shifting the paradigm: the quiet revolution of pediatric procedural sedation practice. Hosp Pediatr. 2018;8(6):372–4. https://doi.org/10.1542/hpeds.2018-0063.

    Article  PubMed  Google Scholar 

  9. Havidich JE, Beach M, Dierdorf SF, Onega T, Suresh G, Cravero JP. Preterm versus term children: analysis of sedation/anesthesia adverse events and longitudinal risk. Pediatrics. 2016;137(3):e20150463. https://doi.org/10.1542/peds.2015-0463.

    Article  PubMed  Google Scholar 

  10. Biber JL, Allareddy V, Allareddy V, Gallagher SM, Couloures KG, Speicher DG, et al. Prevalence and predictors of adverse events during procedural sedation anesthesia-outside the operating room for esophagogastroduodenoscopy and colonoscopy in children: age is an independent predictor of outcomes. Pediatr Crit Care Med. 2015;16(8):e251–9. https://doi.org/10.1097/PCC.0000000000000504.

    Article  PubMed  Google Scholar 

  11. Scherrer PD, Mallory MD, Cravero JP, Lowrie L, Hertzog JH, Berkenbosch JW, et al. The impact of obesity on pediatric procedural sedation-related outcomes: results from the Pediatric Sedation Research Consortium. Paediatr Anaesth. 2015;25(7):689–97. https://doi.org/10.1111/pan.12627.

    Article  PubMed  Google Scholar 

  12. Hirsch DG, Tyo J, Wrotniak BH. Desaturation in procedural sedation for children with long bone fractures: does weight status matter? Am J Emerg Med. 2017;35(8):1060–3. https://doi.org/10.1016/j.ajem.2017.02.036.

    Article  PubMed  Google Scholar 

  13. Chidambaran V, Sadhasivam S, Diepstraten J, Esslinger H, Cox S, Schnell BM, et al. Evaluation of propofol anesthesia in morbidly obese children and adolescents. BMC Anesthesiol. 2013;13:8. https://doi.org/10.1186/1471-2253-13-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Rogerson CM, Abulebda K, Hobson MJ. Association of BMI with propofol dosing and adverse events in children with cancer undergoing procedural sedation. Hosp Pediatr. 2017;7(9):542–6. https://doi.org/10.1542/hpeds.2016-0191.

    Article  PubMed  Google Scholar 

  15. Mahmoud M, Ishman SL, McConnell K, Fleck R, Shott S, Mylavarapu G, et al. Upper airway reflexes are preserved during dexmedetomidine sedation in children with down syndrome and obstructive sleep apnea. J Clin Sleep Med. 2017;13(5):721–7. https://doi.org/10.5664/jcsm.6592.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Grunwell JR, McCracken C, Fortenberry J, Stockwell J, Kamat P. Risk factors leading to failed procedural sedation in children outside the operating room. Pediatr Emerg Care. 2014;30(6):381–7. https://doi.org/10.1097/PEC.0000000000000143.

    Article  PubMed  Google Scholar 

  17. Kamat PP, Bryan LN, McCracken CE, Simon HK, Berkenbosch JW, Grunwell JR. Procedural sedation in children with autism spectrum disorders: a survey of current practice patterns of the society for pediatric sedation members. Paediatr Anaesth. 2018;28(6):552–7. https://doi.org/10.1111/pan.13387.

    Article  PubMed  Google Scholar 

  18. Kamat PP, Karaga MK, Wisniewski BL, McCracken CE, Simon HK, Sidhu R, et al. Outpatient procedural sedation of patients with autism spectrum disorders for magnetic resonance imaging of the brain using propofol. J Child Neurol. 2018;33(5):313–9. https://doi.org/10.1177/0883073817753908.

    Article  PubMed  Google Scholar 

  19. Abulebda K, Louer R, Lutfi R, Ahmed SS. A comparison of safety and efficacy of dexmedetomidine and propofol in children with autism and autism spectrum disorders undergoing magnetic resonance imaging. J Autism Dev Disord. 2018;48(9):3127–32. https://doi.org/10.1007/s10803-018-3582-1.

    Article  PubMed  Google Scholar 

  20. Ahmed SS, Unland T, Slaven JE, Nitu ME, Rigby MR. Successful use of intravenous dexmedetomidine for magnetic resonance imaging sedation in autistic children. South Med J. 2014;107(9):559–64. https://doi.org/10.14423/SMJ.0000000000000160.

    Article  CAS  PubMed  Google Scholar 

  21. Couloures K, Hill LC, Anderson MA, Buckmaster M. Creation of a pediatric sedation adverse event prediction tool. Crit Care Med Suppl. 2015:e761.

    Google Scholar 

  22. Louer R, McKinney RC, Abu-Sultaneh S, Lutfi R, Abulebda K. Safety and efficacy of a propofol and ketamine based procedural sedation protocol in children with cerebral palsy undergoing botulinum toxin A injections. PM R. 2019;11(12):1320–5. https://doi.org/10.1002/pmrj.12146.

    Article  PubMed  Google Scholar 

  23. Fleck T, Schubert S, Ewert P, Stiller B, Nagdyman N, Berger F. Propofol effect on cerebral oxygenation in children with congenital heart disease. Pediatr Cardiol. 2015;36(3):543–9. https://doi.org/10.1007/s00246-014-1047-7.

    Article  PubMed  Google Scholar 

  24. Pan W, Wang Y, Lin L, Zhou G, Hua X, Mo L. Outcomes of dexmedetomidine treatment in pediatric patients undergoing congenital heart disease surgery: a meta-analysis. Paediatr Anaesth. 2016;26(3):239–48. https://doi.org/10.1111/pan.12820.

    Article  PubMed  Google Scholar 

  25. Gupta P, Whiteside W, Sabati A, Tesoro TM, Gossett JM, Tobias JD, et al. Safety and efficacy of prolonged dexmedetomidine use in critically ill children with heart disease*. Pediatr Crit Care Med. 2012;13(6):660–6. https://doi.org/10.1097/PCC.0b013e318253c7f1.

    Article  PubMed  Google Scholar 

  26. Hammer GB, Drover DR, Cao H, Jackson E, Williams GD, Ramamoorthy C, et al. The effects of dexmedetomidine on cardiac electrophysiology in children. Anesth Analg. 2008;106(1):79–83, table of contents. https://doi.org/10.1213/01.ane.0000297421.92857.4e.

    Article  CAS  PubMed  Google Scholar 

  27. Su F, Hammer GB. Dexmedetomidine: pediatric pharmacology, clinical uses and safety. Expert Opin Drug Saf. 2011;10(1):55–66. https://doi.org/10.1517/14740338.2010.512609.

    Article  CAS  PubMed  Google Scholar 

  28. Chen ML, Chen Q, Zhang JX, Su XY, Tu XZ. Safety and efficacy of chloral hydrate for conscious sedation of infants in the pediatric cardiovascular intensive care unit. Medicine (Baltimore). 2017;96(1):e5482. https://doi.org/10.1097/MD.0000000000005842.

    Article  CAS  Google Scholar 

  29. Patel MM, Kamat PP, McCracken CE, Simon HK. Complications of deep sedation for individual procedures (lumbar puncture alone) versus combined procedures (lumbar puncture and bone marrow aspirate) in Pediatric Oncology patients. Hosp Pediatr. 2016;6(2):95–102. https://doi.org/10.1542/hpeds.2015-0065.

    Article  PubMed  Google Scholar 

  30. Abdolkarimi B, Zareifar S, Golestani Eraghi M, Saleh F. Comparison effect of intravenous ketamine with pethidine for analgesia and sedation during bone marrow procedures in oncologic children: a randomized, double-blinded, crossover trial. Int J Hematol Oncol Stem Cell Res. 2016;10(4):206–11.

    PubMed  PubMed Central  Google Scholar 

  31. Chiaretti A, Ruggiero A, Barbi E, Pierri F, Maurizi P, Fantacci C, et al. Comparison of propofol versus propofol-ketamine combination in pediatric oncologic procedures performed by non-anesthesiologists. Pediatr Blood Cancer. 2011;57(7):1163–7. https://doi.org/10.1002/pbc.23170.

    Article  PubMed  Google Scholar 

  32. Chayapathi V, Kalra M, Bakshi AS, Mahajan A. A comparison of ketamine + midazolam to propofol for procedural sedation for lumbar puncture in pediatric oncology by nonanesthesiologists-a randomized comparative trial. Pediatr Blood Cancer. 2018;65(8):e27108. https://doi.org/10.1002/pbc.27108.

    Article  CAS  PubMed  Google Scholar 

  33. Grunwell JR, Travers C, McCracken CE, Scherrer PD, Stormorken AG, Chumpitazi CE, et al. Procedural sedation outside of the operating room using ketamine in 22,645 children: a report from the pediatric sedation research consortium. Pediatr Crit Care Med. 2016;17(12):1109–16.

    Article  Google Scholar 

  34. Carollo DS, Pestieau S, Bosco R. Dexmedetomidine for anterior mediastinal mass computed tomography-guided biopsy: a case series. Ochsner J. 2013;13(4):541–3.

    PubMed  PubMed Central  Google Scholar 

  35. Burgoyne LL, Anghelescu DL, Tamburro RF, De Armendi AJ. A pediatric patient with mediastinal mass and pulmonary embolus. Paediatr Anaesth. 2006;16(4):487–91.

    Article  Google Scholar 

  36. Beach ML, Cohen DM, Gallagher SM, Cravero JP. Major adverse events and relationship to Nil per Os status in pediatric sedation/anesthesia outside the operating room: a report of the pediatric sedation research consortium. Anesthesiology. 2016;124(1):80–8. https://doi.org/10.1097/ALN.0000000000000933.

    Article  CAS  PubMed  Google Scholar 

  37. Andersson H, Zaren B, Frykholm P. Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to the operating suite. Paediatr Anaesth. 2015;25(8):770–7. https://doi.org/10.1111/pan.12667.

    Article  PubMed  Google Scholar 

  38. Chumpitazi CE, Camp EA, Bhamidipati DR, Montillo AM, Chantal Caviness A, Mayorquin L, et al. Shortened preprocedural fasting in the pediatric emergency department. Am J Emerg Med. 2018;36(9):1577–80. https://doi.org/10.1016/j.ajem.2018.01.033.

    Article  PubMed  Google Scholar 

  39. Clark M, Birisci E, Anderson JE, Anliker CM, Bryant MA, Downs C, et al. The risk of shorter fasting time for pediatric deep sedation. Anesth Essays Res. 2016;10(3):607–12.

    Article  Google Scholar 

  40. Malia L, Laurich VM, Sturm JJ. Adverse events and satisfaction with use of intranasal midazolam for emergency department procedures in children. Am J Emerg Med. 2019;37(1):85–8. https://doi.org/10.1016/j.ajem.2018.04.063.

    Article  PubMed  Google Scholar 

  41. Tsze DS, Mallory MD, Cravero JP. Practice patterns and adverse events of nitrous oxide sedation and analgesia: a report from the Pediatric Sedation Research Consortium. J Pediatr. 2016;169:260–5.e2. https://doi.org/10.1016/j.jpeds.2015.10.019.

    Article  CAS  PubMed  Google Scholar 

  42. Tait AR, Malviya S, Voepel-Lewis T, Munro HM, Seiwert M, Pandit UA. Risk factors for perioperative adverse respiratory events in children with upper respiratory tract infections. Anesthesiology. 2001;95(2):299–306.

    Article  CAS  Google Scholar 

  43. Mallory MD, Travers C, McCracken CE, Hertzog J, Cravero JP. Upper respiratory infections and airway adverse events in pediatric procedural sedation. Pediatrics. 2017;140(1). https://doi.org/10.1542/peds.2017-0009.

  44. Bertolizio G, Astuto M, Ingelmo P. The implications of immunization in the daily practice of pediatric anesthesia. Curr Opin Anaesthesiol. 2017;30(3):368–75. https://doi.org/10.1097/ACO.0000000000000462.

    Article  CAS  PubMed  Google Scholar 

  45. Murat I. Anaphylactic reactions during paediatric anaesthesia; results of the survey of the French Society of Paediatric Anaesthesists (ADARPEF) 1991–1992. Paediatr Anaesth. 1993;3:339–43.

    Article  Google Scholar 

  46. Hertzog JH, Preisberga K, Penfil S. The incidence and nature of allergic and anaphylactic reactions during pediatric procedural sedation: a report from the Pediatric Sedation Research Consortium. Hosp Pediatr. 2019;9:16–23. https://doi.org/10.1542/hpeds.2018-0089.

    Article  PubMed  Google Scholar 

  47. Asserhøj LL, Mosbech H, Krøigaard M, Garvey LH. No evidence for contraindications to the use of propofol in adults allergic to egg, soy or peanut. Br J Anaesth. 2016;116(1):77–82. https://doi.org/10.1093/bja/aev360.

    Article  CAS  PubMed  Google Scholar 

  48. Agarwal R, Kaplan A, Brown R, Coté CJ. Concerns regarding the single operator model of sedation in young children. Pediatrics. 2018;141(4):e20172344. https://doi.org/10.1542/peds.2017-2344.

    Article  PubMed  Google Scholar 

  49. Coté CJ, Wilson S. Guidelines and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics. 2019;143(6):e20191000. https://doi.org/10.1542/peds.2019-1000.

    Article  Google Scholar 

  50. Qiu J, Luo Z. The comparison of dexmedetomidine and ketamine for pediatric dental surgery: a meta-analysis of randomized controlled studies. Medicine (Baltimore). 2019;98(17):e15068. https://doi.org/10.1097/MD.0000000000015068.

    Article  CAS  Google Scholar 

  51. Abulebda K, Abu-Sultaneh S, Ahmed SS, Moser EAS, McKinney RC, Lutfi R. Intensivist-based deep sedation using propofol for pediatric outpatient flexible bronchoscopy. World J Crit Care Med. 2017;6(4):179–84. https://doi.org/10.5492/wjccm.v6.i4.179.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Hasan RA, Reddy R. Sedation with propofol for flexible bronchoscopy in children. Pediatr Pulmonol. 2009;44(4):373–8. https://doi.org/10.1002/ppul.21013.

    Article  PubMed  Google Scholar 

  53. Mondal P, Dalal P, Sathiyadevan N, Snyder DM, Hegde S. Flexible bronchoscopy under bronchoscopist-administered moderate sedation versus general anesthesia: a comparative study in children. Pediatr Allergy Immunol Pulmonol. 2018;31(3):166–73. https://doi.org/10.1089/ped.2018.0887.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Najafi N, Veyckemans F, Vanhonacker D, Legrand C, Van de Velde A, Vandenplas Y, Poelaert J. Incidence and risk factors for adverse events during monitored anesthesia care for gastrointestinal endoscopy in children: a prospective observational study. Eur J Anaesthesiol. 2019;36(6):390–9. https://doi.org/10.1097/EJA.0000000000000995.

    Article  PubMed  Google Scholar 

  55. Kamat PP, Ayestaran FW, Gillespie SE, Sanders RD, Greenbaum LA, Simon HK, et al. Deep procedural sedation by a sedationist team for outpatient pediatric renal biopsies. Pediatr Transplant. 2016;20(3):372–7. https://doi.org/10.1111/petr.12680.

    Article  CAS  PubMed  Google Scholar 

  56. Kim D, Lee EK, Jeong JS, Gil NS, Hahm TS, Shin YH. Incidence and risk factors of unplanned intubation during pediatric sedation for MRI. J Magn Reson Imaging. 2019;49(4):1053–61. https://doi.org/10.1002/jmri.26314.

    Article  PubMed  Google Scholar 

  57. Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH, Pediatric Sedation Research Consortium. The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg. 2009;108(3):795–804. https://doi.org/10.1213/ane.0b013e31818fc334.

    Article  CAS  PubMed  Google Scholar 

  58. Saunders R, Struys MMRF, Pollock RF, Mestek M, Lightdale JR. Patient safety during procedural sedation using capnography monitoring: a systematic review and meta-analysis. BMJ Open. 2017;7(6):e103402. https://doi.org/10.1136/bmjopen-2016-013402.

    Article  Google Scholar 

  59. Graham MR, Brownell M, Chateau DG, Dragan RD, Burchill C, Fransoo RR. Neurodevelopmental assessment in kindergarten in children exposed to general anesthesia before the age of 4 years: a retrospective matched cohort study. Anesthesiology. 2016;125(4):667–77.

    Article  CAS  Google Scholar 

  60. Bhatt M, Johnson DW, Chan J, Taljaard M, Barrowman N, Farion KJ, et al. Risk factors for adverse events in emergency department procedural sedation for children. JAMA Pediatr. 2017;171(10):957–64. https://doi.org/10.1001/jamapediatrics.2017.2135.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Bhatt M, Kennedy RM, Osmond MH, Krauss B, McAllister JD, Ansermino JM, et al. Consensus-based recommendations for standardizing terminology and reporting adverse events for emergency department procedural sedation and analgesia in children. Ann Emerg Med. 2009;53(4):426–435.e4. https://doi.org/10.1016/j.annemergmed.2008.09.030.

    Article  PubMed  Google Scholar 

  62. Zgleszewski SE, Graham DR, Hickey PR, Brustowicz RM, Odegard KC, Koka R, et al. Anesthesiologist- and system-related risk factors for risk-adjusted pediatric anesthesia-related cardiac arrest. Anesth Analg. 2016;122(2):482–9. https://doi.org/10.1213/ANE.0000000000001059.

    Article  CAS  PubMed  Google Scholar 

  63. Kelly CJ, Walker RW. Perioperative pulmonary aspiration is infrequent and low risk in pediatric anesthetic practice. Paediatr Anaesth. 2015;25(1):36–43. https://doi.org/10.1111/pan.12549.

    Article  PubMed  Google Scholar 

  64. Parmar NJ, Couloures K, Kandil S, Arango J, Nardecchia N, Facchini D, Barbiero S, Hausner M, Pahade J. MRI Safety in pediatric patients undergoing sedation: impact of in-situ bi-monthly multi-disciplinary simulation training. Yale New Haven Health Safety, Quality and Experience Conference; 2019.

    Google Scholar 

  65. Pfeifer K, Staib L, Arango J, Kirsch J, Arici M, Kappus L, Pahade J. High-fidelity contrast reaction simulation training: performance comparison of faculty, fellow, and residents. J Am Coll Radiol. 2016;13(1):81–7. https://doi.org/10.1016/j.jacr.2015.08.016.

    Article  PubMed  Google Scholar 

  66. Ben-Ari M, Chayen G, Steiner IP, Schinasi DA, Feldman O, Shavit I. The effect of in situ simulation training on the performance of tasks related to patient safety during sedation. J Anesth. 2018;32(2):300–4. https://doi.org/10.1007/s00540-018-2460-5.

    Article  PubMed  Google Scholar 

  67. Owusu-Agyemang P, Grosshans D, Arunkumar R, Rebello E, Popovich S, Zavala A, et al. Non-invasive anesthesia for children undergoing proton radiation therapy. Radiother Oncol. 2014;111(1):30–4. https://doi.org/10.1016/j.radonc.2014.01.016.

    Article  PubMed  Google Scholar 

  68. Emrath ET, Stockwell JA, McCracken CE, Simon HK, Kamat PP. Provision of deep procedural sedation by a pediatric sedation team at a freestanding imaging center. Pediatr Radiol. 2014;44(8):1020–5. https://doi.org/10.1007/s00247-014-2942-z.

    Article  PubMed  Google Scholar 

  69. Couloures KG, Beach M, Cravero JP, Monroe KK, Hertzog JH. Impact of provider specialty on pediatric procedural sedation complication rates. Pediatrics. 2011;127(5):e1154–60. https://doi.org/10.1542/peds.2010-2960.

    Article  PubMed  Google Scholar 

  70. Monroe KK, Beach M, Reindel R, Badwan L, Couloures KG, Hertzog JH, Cravero JP. Analysis of procedural sedation provided by pediatricians. Pediatr Int. 2013;55(1):17–23. https://doi.org/10.1111/j.1442-200X.2012.03743.x.

    Article  PubMed  Google Scholar 

  71. Sacchetti A, Stander E, Ferguson N, Maniar G, Valko P. Pediatric procedural sedation in the community emergency department: results from the ProSCED registry. Pediatr Emerg Care. 2007;23(4):281–22.

    Article  Google Scholar 

  72. Coté CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics. 2000;106(4):633–44.

    Article  Google Scholar 

  73. Yaster M, Nichols DG, Deshpande JK, Wetzel RC. Midazolam-fentanyl intravenous sedation in children: case report of respiratory arrest. Pediatrics. 1990;86(3):463–7.

    CAS  PubMed  Google Scholar 

  74. Paspatis GA, Charoniti I, Manolaraki M, Vardas E, Papanikolaou N, Anastasiadou A, Gritzali A. Synergistic sedation with oral midazolam as a premedication and intravenous propofol versus intravenous propofol alone in upper gastrointestinal endoscopies in children: a prospective, randomized study. J Pediatr Gastroenterol Nutr. 2006;43(2):195–9.

    Article  CAS  Google Scholar 

  75. Aplin S, Baines D, DE Lima J. Use of the ASA physical status grading system in pediatric practice. Paediatr Anaesth. 2007;17(3):216–22.

    Article  Google Scholar 

  76. Tollinche LE, Yang G, Tan KS, Borchardt R. Interrater variability in ASA physical status assignment: an analysis in the pediatric cancer setting. J Anesth. 2018;32(2):211–8. https://doi.org/10.1007/s00540-018-2463-2.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Mason KP, Roback MG, Chrisp D, Sturzenbaum N, Freeman L, Gozal D, et al. Results from the adverse event sedation reporting tool: a global anthology of 7952 records derived from >160,000 procedural sedation encounters. J Clin Med. 2019;8(12). https://doi.org/10.3390/jcm8122087. pii: E2087.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kevin G. Couloures .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Couloures, K.G., Hertzog, J.H. (2021). Adverse Events: Risk Factors, Predictors, and Outcomes. In: Mason, MD, K.P. (eds) Pediatric Sedation Outside of the Operating Room. Springer, Cham. https://doi.org/10.1007/978-3-030-58406-1_34

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-58406-1_34

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-58405-4

  • Online ISBN: 978-3-030-58406-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics