Incidence and risk factors for adverse events during anesthesiologist-led sedation or anesthesia for diagnostic imaging in children: a prospective, observational cohort study

Age

 >1 y

12/648

1.0

–

 ≤1 y

19/394

2.7 (1.3, 5.6)

2.5 (1.2, 5.3)

ASA classification

 1

2/269

1.0

1

 2

22/633

4.8 (1.1, 20.6)

4.6 (1.1, 19.8)

 3

7/140

7.0 (1.4, 34.3)

6.3 (1.3, 30.9)

Number of drugs used

 1

1/54

1.0

–

 2

13/382

1.8 (0.2, 14.6)

–

>3

17/606

1.5 (0.2, 11.7)

–

Choice of technique

 Sedation

22/710

1.0

–

 General anesthesia

9/332

0.87 (0.4, 1.9)

–

Pulmonary disease

3/134

0.7 (0.2, 2.4)

–

Difficult airway

3/42

2.7 (0.8, 9.1)

–

Age (y)

Mean ± standard deviation,

3.3 ± 3.0

Sex

 Male

615 (59.0%)

 Female

427 (41.0%)

American Society of Anesthesiologists classification

 1

269 (25.8%)

 2

633 (60.7%)

 3

140 (13.4%)

Underlying disease categorized by system

 Neurological system

393 (37.7%)

 Genitourinary system

220 (21.1%)

 Gastrointestinal system

150 (14.4%)

 Eye

70 (6.7%)

 Musculoskeletal system

69 (6.6%)

 Respiratory system

41 (3.9%)

 Hematological system

39 (3.7%)

 Ear, nose, or throat

34 (3.3%)

 Cardiac system

13 (1.2%)

 Endocrine system

8 (0.8%)

 Skin

5 (0.5%)

Imaging procedure

 Computed tomography

267 (25.6%)

 Magnetic resonance imaging

469 (45.0%)

 Nuclear medicine

306 (29.4%)

Type of anesthesia

 Sedation

710 (68.1%)

 General anesthesia

332 (31.9%)

Drug (s) used

More than one drug may have been used in each patient

 Midazolam

970 (93.1%)

 Propofol

818 (78.5%)

 Ketamine

666 (63.9%)

 Sevoflurane

374 (35.9%)

 Opioid

15 (1.4%)

 Thiopental

14 (1.3%)

Airway obstruction

Obstruction of the upper airway necessitating airway management

Apnea

Cessation of breathing for >15 seconds

Desaturation

Reduction in peripheral oxygen saturation ≥10% from baseline

Laryngospasm

Chest movement, but no airflow

Pulmonary aspiration

Evidence of gastric contents in the airway with desaturation

Cardiac arrest

Lack of cardiac output

Hypotension

Systolic blood pressure ≤20% of baseline

Cardiac arrhythmia

Heartbeat variation from the normal rhythm, including bradycardia (heart rate

<100 beats/min in a child less than 1 year old, <80 beats/min in a child >1 year old

to 8 years old, <60 beat/min in a child >8 years old to 15 years old)

Prolonged sedation

Sedation continuing for >30 min after the end of the procedure

Inadequate sedation

Difficulty in completing the procedure because of the child’s anxiety or inability

to remain still

Drug error

Incorrect medication, route, or dosage of drug administration

Drug allergy

An immunological response to medication with proved allergen or improved in

allergic symptoms after antihistamine treatment

Others

Other complications that do not affect the cardiovascular system, for example,

nausea, or vomiting, or both; or change in behavior

Age

 >1 y

113/648

1.0

–

 ≤1 y

53/394

0.7 (0.5, 1.1)

–

ASA classification

 1

41/269

1.0

–

 2

103/633

1.1 (0.7, 1.6)

–

 3

22/140

1.0 (0.5, 1.8)

–

Number of drugs used

 1

1/54

1.0

–

 2

34/382

5.2 (0.7, 38.6)

5.3 (0.7, 39.8)

 > 3

131/606

14.6 (2.0, 106.7)

13.5 (1.8, 99.3)

Choice of technique

 Sedation

93/710

1

–

 General anesthesia

73/332

1.9 (1.3, 2.6)

1.3 (0.9, 1.8)

Respiratory complication (n = 31)

 Airway obstruction (n = 14)

13 (1.2%)

1 (0.1%)

0

 Apnea (n = 2)

2 (0.2%)

0

0

 Desaturation (n = 14)

11 (1.0%)

3 (0.3%)

0

 Laryngospasm (n = 1)

1 (0.1%)

0

0

Cardiovascular complications (n = 7)

 Hypotension (n = 5)

4 (0.4%)

1 (0.1%)

0

 Cardiac arrhythmia (n = 2)

2 (0.2%)

0

0

Quality of sedation (n = 165)

 Prolonged sedation (n = 165)

0

165 (15.8%)

0

Drug allergy (n = 1)

1 (0.1%)

0

0

Others (n = 50)

1 (0.1%)

4 (0.4%)

45 (4.3%)