HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sanborn, P. A. Articles by Mason, K. P. Search for Related Content PubMed PubMed Citation Articles by Sanborn, P. A. Articles by Mason, K. P.

Adverse Cardiovascular and Respiratory Events during Sedation of Pediatric Patients for Imaging Examinations¹

¹ From the Departments of Radiology (P.A.S., P.E.B., P.J.F., L.C., K.P.M.), Biostatistics (D.Z.), and Anesthesia (K.P.M.), Children's Hospital, 300 Longwood Ave, Boston, MA 02115; and Department of Anesthesia, Brigham and Women's Hospital, Boston, Mass (E.M.). Received August 31, 2004; revision requested October 26; revision received January 12, 2005; accepted February 1. Address correspondence to K.P.M. (e-mail: keira.mason{at}tch.harvard.edu).

PURPOSE: To retrospectively identify factors associated with an increased risk of adverse cardiovascular or respiratory events during sedation of pediatric patients for imaging examinations.

MATERIALS AND METHODS: This HIPAA-compliant study was institutional review board approved; the requirement for informed consent was waived. All sedation information—including patient demographics, medications (doses and routes of administration), time required to sedate and before discharge, American Society of Anesthesiologists physical status classification, adverse events, and failed sedations—was maintained in a computerized database. A review of the data on all patients sedated between 1997 and 2003 for magnetic resonance imaging, computed tomography, and interventional radiology revealed associated adverse respiratory events in 70 patients. Adverse respiratory event was defined as oxygen desaturation of at least 5%, pulmonary aspiration, and need for airway resuscitation. Adverse cardiovascular events were defined as cardiac arrest and hemodynamic changes requiring medical therapy. Adverse events were compared between sedation regimens—which included fentanyl, chloral hydrate, pentobarbital, and midazolam hydrochloride—by using the Fisher exact test. Multiple logistic regression analysis was applied to identify potential predictors of adverse events.

RESULTS: Among 16 467 sedations performed, 70 (0.4%) were associated with adverse respiratory events: 58 cases of oxygen desaturation, two pulmonary aspirations, 10 cases of airway resuscitation, and no cardiovascular events. Nearly 30% (n = 20) of the 70 patients who had an adverse event had a history of serious respiratory illness. Logistic regression analysis revealed that neither patient age, weight, or sex nor type of imaging procedure was associated with an increased risk of an adverse event. Use of a single sedation agent was associated with lower adverse event risk than was use of multiple agents (P < .001).

CONCLUSION: Consideration should be given to using single agents, avoiding the use of multidrug sedation regimens, and recognizing that a history of pulmonary disease could be associated with an increased risk of adverse respiratory events despite a currently stable respiratory state.

© RSNA, 2005

This article has been cited by other articles:

				S. E. Zgleszewski, D. Zurakowski, P. J. Fontaine, M. D'Angelo, and K. P. Mason Is Propofol a Safe Alternative to Pentobarbital for Sedation during Pediatric Diagnostic CT? Radiology, May 1, 2008; 247(2): 528 - 534. [Abstract] [Full Text] [PDF]

				N. Federman and S. A. Feig PET/CT in Evaluating Pediatric Malignancies: A Clinician's Perspective J. Nucl. Med., December 1, 2007; 48(12): 1920 - 1922. [Full Text] [PDF]

				F. R. Long High-Resolution Computed Tomography of the Lung in Children with Cystic Fibrosis: Technical Factors Proceedings of the ATS, August 1, 2007; 4(4): 306 - 309. [Abstract] [Full Text] [PDF]

				R. C. Wetzel Don't Confuse the Anesthetic with the Anesthesiologist! Anesth. Analg., October 1, 2006; 103(4): 859 - 862. [Full Text] [PDF]

				P. G. Dalal, D. Murray, T. Cox, J. McAllister, and R. Snider Sedation and Anesthesia Protocols Used for Magnetic Resonance Imaging Studies in Infants: Provider and Pharmacologic Considerations Anesth. Analg., October 1, 2006; 103(4): 863 - 868. [Abstract] [Full Text] [PDF]

				J. P. Cravero, G. T. Blike, M. Beach, S. M. Gallagher, J. H. Hertzog, J. E. Havidich, B. Gelman, and and the Pediatric Sedation Research Consortium Incidence and Nature of Adverse Events During Pediatric Sedation/Anesthesia for Procedures Outside the Operating Room: Report From the Pediatric Sedation Research Consortium Pediatrics, September 1, 2006; 118(3): 1087 - 1096. [Abstract] [Full Text] [PDF]

				K. P. Mason, S. E. Zgleszewski, J. L. Dearden, R. S. Dumont, M. A. Pirich, C. D. Stark, P. D'Angelo, S. MacPherson, P. J. Fontaine, L. Connor, et al. Dexmedetomidine for pediatric sedation for computed tomography imaging studies. Anesth. Analg., July 1, 2006; 103(1): 57 - 62. [Abstract] [Full Text] [PDF]