Lucich Elizabeth A, Adams Nicholas S, Goote Paige C, Girotto John A, Ford Ronald D
Michigan State University College of Human Medicine, Grand Rapids, Mich.
Spectrum Health/Michigan State University Plastic and Reconstructive Surgery Residency, Grand Rapids, Mich.
Plast Reconstr Surg Glob Open. 2020 Apr 21;8(4):e2735. doi: 10.1097/GOX.0000000000002735. eCollection 2020 Apr.
Pediatric emergency department (ED) visits are common. Many are due to injury, which require procedural treatments with sedation. There are many well researched independent predictors of adverse events for pediatric procedural sedation. The duration of sedation as a predictor of adverse events has not been well studied. This study aims to determine the complication rate and severity of procedural sedation as well as determine if the duration of sedation is correlated with an increased risk of complications.
After Institutional Review Board approval, a retrospective study was performed on all patients seen at Helen Devos Children's ED who received sedation from August 1, 2011, to August 15, 2016. Study variables included age, weight, type of procedure, American Society of Anesthesiologist (ASA) physical status class, Mallampati score, comorbidities, sedation medication, sedation time, and complication. A logistic regression was performed assessing risk factors for complications. Statistical significance was assessed at < 0.05.
There were 1,814 patients included in the study. Median sedation time was 20 minutes. There were 70 (3.9%) total complications. Controlling for age, weight, comorbidities, ASA class, Mallampati score, and total sedation medication, sedation time was a significant predictor of a complication (odds ratio: 1.021; 95% CI, 1.004-1.039).
Pediatric patients can safely undergo procedural sedation in the ED. This study demonstrates a high safety profile for long procedural sedations with slight increases in risk as sedation time increases. There is no identifiable time where the duration of sedation significantly increases the risk of complication.
儿科急诊科就诊很常见。许多就诊是由于受伤，这需要在镇静下进行程序性治疗。对于儿科程序性镇静的不良事件，有许多经过充分研究的独立预测因素。作为不良事件预测因素的镇静持续时间尚未得到充分研究。本研究旨在确定程序性镇静的并发症发生率和严重程度，并确定镇静持续时间是否与并发症风险增加相关。
在获得机构审查委员会批准后，对2011年8月1日至2016年8月15日在海伦·德沃斯儿童医院急诊科接受镇静的所有患者进行了一项回顾性研究。研究变量包括年龄、体重、手术类型、美国麻醉医师协会（ASA）身体状况分级、马兰帕蒂评分、合并症、镇静药物、镇静时间和并发症。进行逻辑回归分析以评估并发症的风险因素。统计学显著性以<0.05评估。
该研究共纳入1814例患者。中位镇静时间为20分钟。总共有70例（3.9%）并发症。在控制年龄、体重、合并症、ASA分级、马兰帕蒂评分和总镇静药物后，镇静时间是并发症的显著预测因素（比值比：1.021；95%可信区间，1.004 - 1.039）。
儿科患者可以在急诊科安全地接受程序性镇静。本研究表明，长时间程序性镇静具有较高的安全性，随着镇静时间增加，风险略有增加。没有可确定的时间点，在该时间点镇静持续时间会显著增加并发症风险。
