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A Prospective Pediatric Experience

Egidio Barbi, MD; Tania Gerarduzzi, MD; Federico Marchetti, MD; Elena Neri, MD; Elena Verucci, MD; Irene Bruno, MD; Stefano Martelossi, MD; Giulio Zanazzo, MD; Armando Sarti, MD; Alessandro Ventura, MD

Arch Pediatr Adolesc Med. 2003;157:1097-1103.

Background  The need to perform procedural sedation for children has increased in recent years, and so has the experience of nonanesthesiologists in this field. The use of propofol increases the success of satisfactory deep sedation, but it can produce rapid and profound decreases in level of consciousness and cardiorespiratory function. Data are needed to assess the safety of this drug outside an anesthesiology setting.

Objective  To assess safety and efficacy of procedural sedation with propofol in a pediatric ward of a tertiary-care pediatric teaching hospital with trained personnel and monitoring facilities.

Methods  Patients admitted to the hospital who needed invasive procedures underwent procedural sedation by the pediatric sedation unit with intravenous propofol. A training protocol was developed to educate nurses and residents.

Results  We performed 1059 procedures. Sedation was achieved in all procedures, and all but 1 were successfully performed. No patient required intubation. Transient desaturation resolving spontaneously occurred in 134 (12.7%) of 1059 patients. Major desaturation requiring a short course of ventilation occurred in 4 (0.8%) of 483 patients undergoing upper endoscopies, in 1 (0.3%) of 287 patients undergoing painful procedures, and in none of the 289 patients undergoing colonoscopies. Laryngospasm occurred in 10 (2.1%) of 483 patients undergoing upper endoscopies.

Conclusions  In this experience, the use of propofol with concurrent oxygen administration allowed sedations in children with no significant complications for colonoscopies and painful procedures. Complications in the group of upper endoscopies appear too high for recommending propofol in a sedation unit with residents in attendance. This protocol of procedural sedation by nonanesthesiologists allowed a significant increase in the number of procedures performed with sedation and saved anesthesiology resources.

From the Clinica Pediatrica (Drs Barbi, Gerarduzzi, Marchetti, Neri, Verucci, Bruno, and Ventura), Servizio di Gastroenterologia (Dr Martelossi), Servizio di Emato-Oncologia (Dr Zanazzo), and Servizio di Anestesia e Rianimazione (Dr Sarti), Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, University of Trieste, Trieste, Italy.

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