Lovely descriptive statistics of 25,000 occurrences of propofol sedation in children.
Interestingly – 75% of their sedations occurred in radiology. My experience has primarily been to sedate children for uncomfortable procedures – but I am aware that our pediatric critical care intensivists staff the MRI machine specifically to run sedations for children for imaging.
2.3% had “serious adverse events” – although their “other adverse events” includes 1.3% who had “unexpected need for PPV”, which, to me, seems rather serious. 1% had airway obstruction, another 1% had desaturation and 0.5% had apnea. They also did some chart mining to see if anything showed up as associated with a serious adverse event. The highest OR was only 4.6, and that was when an “upper respiratory” diagnosis was documented in the chart. Other associations included prematurity, and then the addition of benzo, ketamine, anticholinergics, or opioids to the sedation.
I would say there are a couple emerging trends that might help further increase sedation safety – addition of end-tidal CO2 monitoring might give better warning of apnea and desaturation, and increased use of nitrous oxide may reduce the number of propofol sedations needed. Otherwise – be ready for too much excitement in one out of fifty pediatric sedations.