[1650.1] Use of Propofol for Sedation of Pediatric Patients by Emergency Physicians: A Report from the Pediatric Sedation Research Consortium

Michael D. Mallory, Amy L. Baxter, Daniel J. Yanosky, Joseph P. Cravero. Pediatric Emergency Medicine Associates, Children's Healthcare of Atlanta, Atlanta, GA; Dept of Mathematics and Statistics, Kennesaw State University, Kennesaw, GA; Dept of Anesthesiology and Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH.

BACKGROUND: Procedural sedation is performed by a wide variety of pediatric specialists. Emergency physicians have become progressively more involved in pediatric sedation, both in the emergency department and in other settings. Propofol is a common choice of emergency physicians when sedating children.
OBJECTIVE: Use a multi-center prospective database to describe sedation of pediatric patients by emergency physicians using propofol primarily for elective procedures, and to identify patient characteristics associated with adverse events.
DESIGN/METHODS: We identified sedations performed by emergency physicians using propofol that were entered in the database of the Pediatric Sedation Research Consortium (PSRC). Descriptive characteristics of patients, procedures, adjunct medications, and adverse events are reported. Multiple logistic regression models using a stepwise variable selection process were evaluated to determine patient characteristics that were associated with adverse events.
RESULTS: Of 25,433 propofol sedations performed by emergency physicians, 22,068 were performed in radiology, 4,459 in a dedicated sedation unit, 918 in a pediatric specialty clinic, 543 in other locations, and 211 in the Emergency Department (ED). The cumulative incidence of airway and respiratory adverse events was 991 (3.9%), including two aspirations and one cardiac arrest. 602 patients required interventions beyond airway repositioning (2.4%). Stepwise logistic regression was used to identify variables associated with complications. Factors that demonstrated an independent association with the occurrence of any adverse event included: age less than 2 months (odds ratio [OR] 4.42; 95% confidence interval [CI] 2.05 to 9.58; n=47), ASA classification of greater than 2 (OR 1.67; CI 1.46 to 1.90), use of adjunctive opioids (OR 3.27; CI 2.52 to 4.25), midazolam (OR 2.61; CI 2.01 to 3.40), and adjunctive use of anticholinergics (OR 2.37; CI 1.83 to 3.08). Sedation for painful procedures was associated with a lower risk of adverse events (OR 0.51; CI 0.39 to 0.66).
CONCLUSIONS: We report the largest series of pediatric sedations by emergency physicians using propofol. In this population, younger and sicker patients, and patient receiving adjunctive sedation, opioids, or anticholinergic medications appear to be more likely to experience adverse events.
E-PAS20101650.1

Date: Saturday, May 1, 2010
Platform Session: Emergency Medicine II (2:45 PM - 4:45 PM)
Presentation Time: 2:45 PM
Room: East Ballroom A - Vancouver Convention Centre
Course Number: 1650