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Delayed Adverse Events after Procedural Sedation in Pediatric Patients with Hematologic Malignancies
Jin Joo1, Sanghyuck Yu1, Hyun Jung Koh1
1Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
Insights
Delayed adverse events following procedural sedation for pediatric bone marrow examination or intrathecal chemotherapy are common, particularly in inpatients. While dizziness and headache were most frequent, all sedative types proved safe for use.
Area of Science:
- Pediatric Hematology
- Anesthesiology
- Pharmacology
Background:
- Procedural sedation is essential for pediatric hematology patients undergoing bone marrow examination (BME) and intrathecal chemotherapy (ITC).
- Delayed adverse events (AEs) post-discharge from recovery are not well-documented.
- This study investigates AEs occurring up to 24 hours after sedation for BME or ITC.
Purpose of the Study:
- To evaluate the types and incidence of delayed adverse events in pediatric patients receiving deep sedation for BME or ITC.
- To compare adverse events between inpatients and outpatients.
- To assess the impact of sedative agent composition on adverse events.
Main Methods:
- Retrospective analysis of 263 pediatric patients (inpatients and outpatients) undergoing BME or ITC under deep sedation.
- Adverse events were assessed at 2, 12, and 24 hours post-procedure (T1, T2, T3) and their duration recorded (D1, D2, D3).
- Patients were grouped based on inpatient/outpatient status and the proportion of ketamine in propofol-ketamine mixtures.
Main Results:
- Overall incidence of adverse events was higher in inpatients (48.3%) versus outpatients (33.6%) (p=0.011).
- Significant differences in AE rates were observed between groups at T1 and T2 (p<0.001).
- A higher proportion of ketamine in propofol-ketamine mixtures correlated with more T1 adverse events (34.6%) compared to lower ketamine proportions or propofol alone (p=0.012).
Conclusions:
- The most common delayed adverse events were dizziness and headache, typically resolving within 12 hours.
- Propofol-ketamine combinations with higher ketamine ratios may increase early post-procedure adverse events.
- Despite observed events, all evaluated sedative regimens appear safe for pediatric patients undergoing BME or ITC without requiring additional management.
Abstract:
Background and objectives: Procedural sedation for bone marrow examination (BME) and intrathecal chemotherapy (ITC) is necessary for pediatric patients with hematological malignancies. There has been no report on adverse events after discharge from the recovery room. This retrospective study evaluated the types and incidences of delayed adverse events among pediatric patients scheduled for BME or ITC under deep sedation in a single center for 3 years. Materials and Methods: The patients were divided into two groups: inpatients (group I) and outpatients (group O). All patients were managed during the procedures and the recovery period. In total, 10 adverse events were assessed; these occurred 2 h (T1, acute), 12 h (T2, early), and 24 h (T3, delayed) after the procedure. The duration of each adverse event was also recorded and was classified as 2 h (D1), 12 h (D2), or 24 h (D3). The data of 263 patients (147 inpatients and 116 outpatients) who met the inclusion criteria were analyzed. Results: The overall incidence of adverse events was statistically significant difference: 48.3% in group I and 33.6% in group O (p = 0.011). The rates of adverse events at T1 and T2 were significantly different between groups I and O (42.8% vs. 11.2% and 7.5% vs. 20.7%, respectively) (p < 0.001). The adverse events were mostly of D1 or D2 duration in both groups. Patients with a higher proportion of ketamine in a propofol−ketamine mixture had a significantly higher proportion of adverse events at T1 (34.6%), as compared with those with a mixture with a lower proportion of ketamine (21.1%) or propofol alone (17.9%) (p = 0.012). Conclusions: The most common adverse events were dizziness or headache; typically, they did not last longer than 12 h. The propofol-ketamine combination with a higher proportion of ketamine seems to produce more adverse events within 2 h after the procedure. Nevertheless, all sedative types appear safe to use without additional management.
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