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Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model. Pediatrics 2002 Feb;109(2):236-43

Date

02/05/2002

Pubmed ID

11826201

DOI

10.1542/peds.109.2.236

Scopus ID

2-s2.0-0036164093   242 Citations

Abstract

OBJECTIVE: Guidelines for risk reduction during procedural sedation from the American Academy of Pediatrics (AAP) and the American Society of Anesthesiologists (ASA) rely on expert opinion and consensus. In this article, we tested the hypothesis that application of an AAP/ASA-structured model would reduce the risk of sedation-related adverse events.

METHODS: Prospectively coded sedation records were abstracted by a hospital quality improvement specialist with practical and administrative experience in pediatric sedation. Process variables included notation of nulla per os (NPO) status, performance of a guided risk assessment, assignment of ASA physical status score, obtaining informed consent, generation of a sedation plan, and assessment of sedation level using a quantitative scoring system. Content variables included adherence to AAP NPO guidelines, ASA class, target sedation level, actual sedation level, age, procedure, and drugs used. Complication risk was assessed by logistic regression and Mantel-Haenszel odds ratios (OR).

RESULTS: Complications were identified in 40 of 960 records (4.2%). The complication rate was 34 of 895 (3.8%) with planned conscious sedation and 6 of 65 (9.2%) with planned deep sedation ([DS]; OR: 2.6). Complications were reduced by performance of structured risk assessment (OR: 0.10), adherence to all process guidelines (OR: 0), and avoiding actual DS (OR: 0.4). The only drug associated with higher risk was chloral hydrate (OR: 2.1). Failure to adhere to NPO guidelines did not increase risk in this assessment; however, the adverse event rate was 0 if all process guidelines were followed.

CONCLUSIONS: Presedation assessment reduces complications of DS. Repeated assessment of sedation score reduces the risk of inadvertent DS. The data provide direct evidence that AAP/ASA guidelines can reduce the risk of pediatric procedural sedation.

Author List

Hoffman GM, Nowakowski R, Troshynski TJ, Berens RJ, Weisman SJ

Authors

Richard J. Berens MD Professor in the Anesthesiology department at Medical College of Wisconsin
George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Todd J. Troshynski MD Associate Professor in the Anesthesiology department at Medical College of Wisconsin
Steven J. Weisman MD Professor in the Anesthesiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Anesthesia
Anesthesiology
Conscious Sedation
Female
Hospitals, Pediatric
Humans
Infant
Infant, Newborn
Male
Models, Statistical
Oximetry
Pediatrics
Practice Guidelines as Topic
Risk Assessment
Risk Factors
Societies, Medical
United States
Wisconsin
jenkins-FCD Prod-484 8aa07fc50b7f6d102f3dda2f4c7056ff84294d1d