Safe Procedural Sedation for Radiological Studies in Children Using Propofol by a Pediatric Hospitalist Team

1Washington University School of Medicine, St. Louis, MO
2Washington University School Of Medicine, St. Louis, MO
3Washington University School of Medicine, St. Louis, MO
4Washington University School of Medicine, St. Louis, MO

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 139

Background:

There is increasing use of propofol by nonanesthesiologists to sedate children for ambulatory diagnostic imaging studies. There is little published data on the safety profile and frequency of adverse events when propofol is used by pediatricians without subspedalty training.

Methods:

Sedation‐trained pediatric hospitalists have performed more than 1500 propofol sedations from January 2005 to September 2009 in our hospital. We plan to obtain the sedation records of these patients, including patient demographics and American Society of Anesthesiologists (ASA) status, procedures performed, agents used for sedation, and complications during the case. Preliminary results from 103 patients sedated during this time period have been analyzed.

Results:

Mean age of patients sedated was 51 months, with a range of 6‐202 months. Fifty‐five percent of patients were ASA 2, 39% were ASA 1, and 6% were ASA 3. All patients received propofol, and 27% of patients were premedicated with oral versed prior to IV placement. There were no episodes of symptomatic hypotension, aspiration, laryngospasm, emergent intubations, or unplanned admission. Three patients needed airway interventions for apnea and obstruction, which are anticipated during propofol use and were managed successfully by the hospitalists. One patient (ASA 2) had apnea requiring bag mask ventilation (BMV) dunng induction, which resolved, and the procedure was completed. Two patients experienced obstruction. The study was aborted in 1 patient [ASA 2. history of upper respiratory tract infection (URI), premeditated with Versed] who required continuous positive airway pressure/BMV/oral airway and a nasal trumpet. The procedure was completed in the second patient (ASA 3, history of snoring, premedicated with Versed) after placement of an oral airway.

Conclusions:

Our preliminary results suggest that propofol can be used safely by pediatric hospital ists with sedation training in an ambulatory procedure center with minimal adverse events. Presence of URI or history of snoring in combination with Versed may increase the risk of obstruction. We will review the remaining 1500 patient charts to confirm these findings as well as to identify risk factors for adverse events.

Author Disclosure:

M. Srinivasan, none; L. Moscoso, none; M. Turmelle, none; D. Carlson, none.

To cite this abstract:

Srinivasan M, Moscoso L, Turmelle M, Carlson D. Safe Procedural Sedation for Radiological Studies in Children Using Propofol by a Pediatric Hospitalist Team. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 139. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/safe-procedural-sedation-for-radiological-studies-in-children-using-propofol-by-a-pediatric-hospitalist-team/. Accessed May 26, 2019.

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