Adverse Sedation Events

Resident’s Name: Joanne Lewis Date: April 2, 2010

Article title: Adverse Sedation Events in Pediatrics: A Critical Incident Analysis of Contributing Factors

Author(s): Charles J. Cote MD, et al

Journal: Pediatrics

Volume (number): 105 (4)

Date: 2000

Major topic: adverse sedation events in children

Type of Article: research article

Main Purpose: to examine the factors that contribute to adverse sedation events in children undergoing procedures.

Overview of method of research: 118 reports involving an adverse sedation event were reviewed for factors that may have contributed to the adverse event. Examples of some contributing events: drug overdose, inadequate monitoring, inadequate resuscitation, premature discharge, etc. The outcomes were classified as no harm, prolonged hospitalization without injury, permanent neurological injury, or death. 4 physicians examined reports; 95 reports for which the physicians agreed on the contributing factors and outcome were included in the final analysis

Findings: Patients sedated in a non-hospital setting were older and healthier than patients treated in a hospital setting. Respiratory compromise was the initial observed event in more than 80% of the cases; cardiac arrest was the 2^nd or 3^rd event much more frequently in patients treated in a non-hospital setting. Death or permanent neurological injury was the outcome more frequently in patients cared for in a non-hospital facility. Inadequate resuscitation was more common in management of nonhospital-based adverse events. There was a strong correlation between successful outcomes (no harm or prolonged hospitalization with no injury) and patients monitored with a pulse ox; this was especially true for the patients treated in a hospital. However, 4 out of 5 patients cared for in a nonhospital-based facility suffered death or permanent neurological injury despite pulse ox monitoring. 32 of the adverse events were dental related.

Key points/Summary: Uniform guidelines for monitoring children undergoing sedation should be in place, whether the patient is sedated in a hospital or non-hospital setting. Pulse ox monitoring should be used in all sedations. All health care providers who sedate children should have advanced airway management and resuscitation skills.

Assessment of article: Relevant.