Avoiding Adverse Events in Pediatric Sedation

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This large multi-center prospective study of pediatric sedation found adverse events occurred in 12%; most were mild desaturation or vomiting.  Severe adverse events occurred in 1%.  Ketamine given alone was the safest drug.  Propofol alone, ketamine + fentanyl, or ketamine + propofol were associated with greater risk for severe adverse events.

Why does this matter?
Procedural sedation is a part of pediatric emergency and critical care practice. Doing it safely is of paramount importance.  This paper helps us learn which sedation practices are the safest.

So...maybe no ketofol for kids?
This was a very large prospective study in 6 Canadian pediatric centers with almost 6300 children included.  They found that overall adverse events occurred in about 12%; severe adverse events in 1%.  The most common mild adverse events were desaturation and vomiting. Vomiting risk decreased 50% with pre-procedural anti-emetic administration. The most common intervention for severe events was simple positive pressure ventilation.  There were no episodes of pulmonary aspiration, despite a 5% incidence of vomiting and >21% of patients having NPO times < 4 hours; of those, 5% were NPO < 2 hours. Risk factors for severe adverse events were greatest when using propofol only or any combination of ketamine with fentanyl or ketamine with propofol.

Source
Risk Factors for Adverse Events in Emergency Department Procedural Sedation for Children.  JAMA Pediatr. 2017 Aug 21. doi: 10.1001/jamapediatrics.2017.2135. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.

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