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Pediatric procedural sedation in Japan: A single-facility study of 1,436 cases
Shuji Kuga1, Tomoki Maeda1, Kenji Ihara1
1Department of Pediatrics, Faculty of Medicine, Oita University, Yufu, Japan.
Insights
Pediatric procedural sedation (PPS) in Japan resulted in a 16.2% adverse event rate, primarily minor events like oxygen desaturation. Risk factors identified include higher ASA classification and longer procedure times.
Area of Science:
- Pediatric Anesthesiology
- Patient Safety
Background:
- Pediatric procedural sedation (PPS) is standard globally but lacks comprehensive data in Japan.
- The current status and adverse events of PPS in Japan remain unclear.
Purpose of the Study:
- To investigate the current status of PPS in Japan.
- To clarify PPS-related adverse events and identify associated risk factors.
Main Methods:
- A single-facility database survey at Oita University Hospital (September 2016 - March 2019).
- Inclusion of children under 18 undergoing intravenous sedation for medical procedures.
- Adverse events recorded and classified using the Quebec Guideline.
Main Results:
- 1,436 PPS cases were analyzed; 94% used thiamylal-based sedation.
- 253 adverse events (16.2%) occurred, including oxygen desaturation and vomiting; all resolved with simple interventions.
- No severe adverse events or need for endotracheal intubation were reported.
- Higher ASA classification, longer procedures, non-compliance with NPO, and lack of PALS-certified staff were risk factors for adverse events.
Conclusions:
- Adverse events occurred in 16.2% of pediatric procedural sedation cases in this Japanese cohort.
- Further research is necessary to analyze serious adverse events and risk factors for PPS in Japan.
Background:
Pediatric procedural sedation (PPS) has been established worldwide as standard practice for several decades. However, there are no comprehensive guidelines or multi-facility databases of PPS in Japan, and the current status of PPS and PPS-related adverse events is unclear. The objectives of this study were to investigate the status of PPS in Japan and clarify the adverse events and risk factors.
Methods:
This study was a single-facility, database survey performed at Oita University Hospital from September 2016 to March 2019. Children under 18 years of age who had been kept sedated for medical procedures with intravenous sedatives were enrolled in this study. Adverse events were recorded and defined according to the Quebec Guideline.
Results:
During the study period, PPS was performed for 1,436 consecutive cases. The majority (94%) of the sedatives used were thiamylal alone or thiamylal combined with ketamine. There were a total of 253 adverse events in 233 cases (16.2%), including oxygen desaturation, airway hypersensitivity, and vomiting. Patients recovered from respiratory-related adverse events immediately with simple intervention. No patient required endotracheal intubation and no severe adverse event occurred. Four risk factors (a higher American Society of Anesthesiologists classification, longer procedure time, non-compliance of nil per os status, and no Pediatric Advanced Life Support certification for sedation personnel) were associated with the occurrence of adverse events.
Conclusions:
Adverse events occurred in 16.2% of all PPS cases. Further studies are needed to analyze the serious adverse events and risk factors for PPS in Japan.
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