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

Background/Objectives: While the 2024 international expert consensus acknowledges that operator-managed sedation (OMS) may provide equal safety to anesthesiologist-directed care, it emphasizes clinical judgment over numerical risk scores alone, yet supporting institutional data remain limited. We evaluated the safety outcomes and risk factors for adverse events (AEs) during OMS at a single tertiary center. Methods: We retrospectively reviewed 342 cardiac catheterization procedures in pediatric patients under six years of age performed under OMS between 2020 and 2022. Results: A total of 342 cardiac catheterization procedures were performed in 307 patients, of which 30.4% were diagnostic. The overall incidence of AEs was 7.0%, and all events were successfully managed with complete recovery. In the univariate analysis, neonatal age (OR = 13.5, p < 0.001), body weight ≤ 10 kg (OR = 3.04, p = 0.01), and genetic abnormalities (OR = 3.92, p = 0.023) were identified as significant risk factors. Neonatal age and genetic abnormalities remained significant in the multivariate analysis. The incidence of AEs increased with higher Catheterization Risk Score for Pediatrics (CRISP) scores, showing a significant linear trend (p < 0.001), whereas no sedation-related AEs occurred in patients with scores below 2. Conversion to GA occurred only in patients with CRISP scores above 5. Conclusions: OMS can be performed safely across a wide CRISP score range in experienced centers. Neonatal age and genetic abnormalities were associated with increased AE risk; however, case selection should be guided by each patient's overall clinical picture rather than any single risk factor alone.