Operator-Managed Sedation for Pediatric Cardiac Catheterization: Experience and Safety in a Single-Center Cohort

Area of Science:

• Pediatric Cardiology
• Anesthesiology
• Sedation Management

Background:

• International consensus supports operator-managed sedation (OMS) safety, comparable to anesthesiologist-directed care.
• Limited institutional data exist on OMS safety outcomes and risk factors.
• This study evaluates adverse events (AEs) during OMS in pediatric cardiac catheterization.

Purpose of the Study:

• To assess safety outcomes of OMS in pediatric cardiac catheterization.
• To identify risk factors for AEs during OMS.
• To correlate AEs with the Catheterization Risk Score for Pediatrics (CRISP).

Main Methods:

• Retrospective review of 342 pediatric cardiac catheterizations under OMS (2020-2022).
• Analysis of patient demographics, procedure types, and AE occurrence.
• Univariate and multivariate analyses of risk factors and CRISP scores.

Main Results:

• Overall AE incidence was 7.0%, with all events successfully managed.
• Significant risk factors for AEs included neonatal age (OR=13.5) and genetic abnormalities (OR=3.92).
• AE incidence increased with higher CRISP scores; no AEs occurred with CRISP < 2. General anesthesia conversion occurred only with CRISP > 5.

Conclusions:

• OMS is safe for pediatric cardiac catheterization across a broad CRISP score range in experienced centers.
• Neonatal age and genetic abnormalities are associated with increased AE risk.
• Patient selection for OMS should integrate clinical judgment beyond single risk factors.