Paediatric procedural sedation at a tertiary care university teaching hospital in India

Anagha Dubhashi,Courtney McCracken,Kiran Hebbar,Pradip Kamat,Maria Silveira

doi:10.4038/sljch.v47i1.8423

Abstract

Introduction: Although paediatric procedural sedation (PPS) using propofol is routine in the United States, its use is restricted to anaesthesiologists in many other countries like India. As a result the paediatric providers have to use other drugs for PPS. Objective: To report a single centre experience of children receiving PPS at a tertiary care university teaching hospital. Method: A retrospective chart review of PPS at Goa Medical College, Goa, India was provided by the paediatric senior resident, supervised by a paediatric consultant, both certified in Paediatric Advanced Life Support (PALS) and with experience in non-propofol PPS. We collected demographics, drug and dosing information, indication for PPS, procedure success rates and adverse events. Sedation related minor adverse events are complications during PPS, which are easily handled, and not expected to be associated with any sequelae. Serious adverse events include aspiration, airway obstruction, laryngospasm, emergent anaesthesia consult, cardiac arrest and death. Results: Procedural sedation from 249 children from April-September 2015 were included in this study. Magnetic resonance imaging (MRI) 138/249 (55.4%), computed tomography (CT) scan 61 (24.5%), electroencephalogram (EEG) 26 (10.4%) and other procedures 24 (9.6%). Median age was 22 months (25th – 75th: 12-36), 140 (56.2%) were female, and 227 (91.5%) were American Society of Anaesthesiologists Physical Status (ASA-PS) ≤III. Overall success was 213 (85.5%). Commonly used agents included intravenous (IV) midazolam 188 (75.5%), IV dexmedetomidine 37 (14.9%), and oral chloral hydrate 24 (9.6%). Ramsey sedation score of 3 or greater was achieved in 220 (88.4 %) sedation after adding a second drug. Serious adverse events were seen in 3 (1.2%) patients. Sedation related minor adverse effects included: change in heart rate (>25% from baseline) 47 (18.9%), oxygen desaturation ( Conclusion: Intravenous midazolam was the commonest agent used for procedural sedation at Goa Medical College, India. Sri Lanka Journal of Child Health, 2018; 47 (1): 8-15

Highlights

Paediatric procedural sedation (PPS) using propofol is routine in the United States, its use is restricted to anaesthesiologists in many other countries like India
Median age was 22 months (25th–75th: 12-36), 140 (56.2%) were female, and 227 (91.5%) were American Society of Anaesthesiologists Physical Status (ASA-PS) ≤III. 1Goa Medical College, India, 2Children's Healthcare of Atlanta at Egleston, Emory University School of Medicine Atlanta, USA, 3Emory University School of Medicine, Atlanta, USA *Correspondence: anaghasambari@rediffmail.com (Received on 23 March 2017: Accepted after revision on 19 May 2017) The authors declare that there are no conflicts of interest Personal funding was used for the project
This study focuses on the sedation provided by general paediatricians at a tertiary care university teaching hospital in India

Summary

Introduction

Paediatric procedural sedation (PPS) using propofol is routine in the United States, its use is restricted to anaesthesiologists in many other countries like India. As a result the paediatric providers have to use other drugs for PPS. The aim of PPS is to provide sedation, analgesia, amnesia and immobility if required for the successful completion of the procedure. In the United States (US) a significant number of children receive PPS outside the operating room provided by various paediatric subspecialists such as from paediatric critical care, paediatric emergency medicine, and paediatric hospitalists[1]. PPS performed by paediatric subspecialists outside the operating room in the US has been shown to be highly effective, resulting in cost saving and improved parental satisfaction[4,5,6]. Published surveys suggest significant variation in the sedation provider, the location of procedure (operating room vs. outside the operating room) and medications used[9,10]

Methods

Results

Conclusion