Procedural sedation programme minimising adverse events: a 3-year experience from a tertiary paediatric emergency...

Area of Science:

• Pediatric Emergency Medicine
• Anesthesiology
• Clinical Governance

Background:

• Procedural sedation in pediatric emergency departments requires adherence to best practices to minimize adverse events.
• Establishing a new tertiary pediatric hospital necessitates evaluating the safety of its sedation program.

Purpose of the Study:

• To examine the safety and efficacy of a newly established procedural sedation program in a tertiary pediatric hospital.
• To assess adherence to evidence-based practices in pediatric procedural sedation.

Main Methods:

• Utilized a robust provider training and privileging system.
• Implemented standardized policies and procedures for sedation.
• Conducted rigorous data collection within an evidence-based clinical governance framework.
• Analyzed sedation data from July 2018 to May 2022.

Main Results:

• Ketamine was administered in 3388 of 3405 sedations (99.5%).
• The mean age of sedated children was 5.5 years, with common indications including fracture reduction and laceration repair.
• Overall adverse events occurred in 4.37% of cases, with vomiting (2.59%) and airway/breathing issues (1.48%) being most frequent. Specific events included oxygen desaturation (1.18%), laryngospasm (0.18%), and apnea (0.12%).

Conclusions:

• Adherence to international standards for provider skills, training, drug administration, and monitoring optimizes patient safety.
• A strict clinical governance process is crucial for the safe delivery of pediatric procedural sedation.
• This study provides a large dataset on intravenous ketamine use in pediatric procedural sedation, supporting its safe application within a structured program.