Sedation, Risk, and Safety: Do We Really Have Data at Last?

Abstract

The July 2001 issue of Pediatrics contained a commentary by Freeman entitled “The Risk of Sedation for Electroencephalograms: Data at Last.”1 This commentary, written to accompany a paper by Olson et al,2 made several statements based on erroneous statistical inference. We are grateful to the editors of Pediatrics for granting us this forum in which to respond to that commentary. The great importance of safety for children who need sedation is clearly reflected in past publications of this journal, most notably the American Academy of Pediatrics (AAP) “Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures.”3 We, as did Dr Freeman, commend Olson and colleagues for demonstrating that sedation for electroencephalograms (EEGs) in children is usually not necessary when effective behavioral techniques are employed. Nevertheless, there are occasions when behavioral techniques are inadequate, as demonstrated by the 513 patients (18% of the total in this series) who received sedation with chloral hydrate and other drugs. Three of these patients developed oxygen desaturation to between 82% and 88%. This corresponds to a Pao2 of about 45 to 55, a significant degree of hypoxemia. Although transient hypoxemia is unlikely to lead to long-term consequences, unrecognized or inadequately treated hypoxemia, especially when related to airway obstruction, may progress to more severe complications. It is to the investigators' credit that their compliance with the AAP guidelines for monitoring during sedation resulted in prompt recognition and treatment of the airway problems without sequelae. This ability to rescue from complications is strongly emphasized in the 2001 standards of the Joint Commission on Accreditation of …