The Nature, Frequency, and Timing of Pediatric Sedation Adverse Events

The nature and frequency of pediatric sedation adverse events (AEs) have been well described. However, the timing of specific AEs in induction, procedure, and recovery phase of sedation remains unknown. The objective was to describe the nature, frequency, and timing of AEs. We hypothesized that most AEs would start at the induction phase.

We examined prospectively collected data of sedation encounters of children 3 months to 18 years of age, characterized by at least 1 AE, from January 1, 2013 to December 31, 2020. Patient characteristics, primary diagnosis, procedure type, nature, frequency, and timing of AEs were reported.

Of 12 012 sedation encounters, the mean age was 7.6 (SD = 4.9) years, most (89%) were American Society of Anesthesiologists II risk, the most common diagnosis was hematology/oncology (27.3%) and the most common procedure radiologic (47.8%). At least 1 AE occurred during 765 (6.4%) encounters. Respiratory AEs were most common (n = 645, 5.4% of all encounters) and started more often during induction (64.5% of respiratory AEs). Partial upper airway obstruction was the most common respiratory AE (2.8% of all encounters). Partial (59.4%) and complete (77.3%) upper airway obstruction and apnea (84%) all began more often during induction. Laryngospasm (48.4% vs 46.8%) and hypoxemia (59.3% vs 39%) were similarly distributed between induction and procedure, respectively, though they were rare during recovery.

Most respiratory events in this cohort started during the induction or procedure phases. The sedation team should be especially prepared to administer rescue maneuvers and allocate staff/resources during these phases.