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Qualified specialists urged for pediatric sedation

Couloures KG. Pediatrics. 2011;127:e1154-e1160.

Sedating a child is unlikely to yield major complications, regardless of provider specialty, as long as the child is sedated by qualified personnel, according to a study published online.

Sedation-related complications are more likely to occur in children than in adults because their smaller anatomic makeup make them more susceptible to respiratory distress, according to Kevin G. Couloures, DO, MPH, of Nemours Children’s Clinic-Wilmington, Alfred I. duPont Hospital for Children, in Wilmington, Del., and colleagues.

Couloures and colleagues said the dwindling rate of qualified anesthesiologists has prompted use of pediatric specialists and other personnel to perform these procedures, which raises questions about rates of complications. The researchers prospectively collected data between July 1, 2004, and Dec. 31, 2008. They used a Web-based collection tool that asked a series of questions for each procedure.

The researchers noted 122 incidences of major complications of the 131,751 instances in which sedation was used in a pediatric procedure. No deaths were reported. The researchers noted no statistical difference between providers’ complication rates before or after, adjusting for emergency status, medication and site.

The researchers noted a variety of procedures, including radiology, followed by hematology/oncology, minor surgical procedures endoscopy/colonoscopy and bronchoscopy/laryngoscopy. Propofol, midazolam and pentobarbital were the most commonly used medications.

“The rapid growth in the use of sedation services by non-anesthesiologists has been the subject of some concern,” Couloures and colleagues said. “Our data reveal that, within our consortium, there was no increased danger associated with pediatric procedural sedation provided by non-anesthesiologists.”

Disclosure: The researchers report no relevant financial disclosures. The study was supported by the National Patient Safety Foundation.

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