Establishing the first ever pediatric procedural sedation clinic in a low-income country: Assessment of the safety and efficacy.

BACKGROUND

Pediatric sedation clinics are rare in low-income countries. Our aim is to describe the establishment of the first-ever pediatric sedation clinic in Ethiopia and provide an assessment of its safety and efficacy over the 5 years since its establishment.

METHODS

A multi-phase approach was undertaken. In the first phase, we analyzed barriers to procedural pain management through repeated focus group discussions with stakeholders. Subsequently, we conducted a modified sedation provider course from the Society for Pediatric Sedation (SPS) with pre and post-training testing to document course effectiveness. Finally, we developed a procedural sedation clinic at Tikur Anbessa Specialized Hospital. In the second phase, we prospectively collected outcome data over a 5-year period from patients receiving procedural sedation at the clinic. This included assessing the efficacy of sedation and documenting any adverse events that occurred during the procedures.

RESULT

One hundred three providers completed the procedural sedation course. There was a 13.4% improvement in knowledge between baseline and post-course testing. A total of 2,820 patients underwent procedural sedation over the 5-year period from 2016 through 2021, and data selected from 475 (16.8%) patients were analyzed. The most common procedure performed was bone marrow aspiration/biopsy in 384 subjects (80.8%). The most common procedural sedation used was the combination of ketamine and propofol in 60.6%. The mean pain score during the procedure was 0.28/10, which was significantly lower than the pre-procedural pain score (p-value < 0.001). A total of 9 (1.9%) patients had adverse events and there was no mortality.

CONCLUSION

Based on our experience, development of a safe and effective sedation clinic is possible in resource-limited settings as evidenced by low procedural pain scores, and low adverse events rates. Provider training based on a modification of the SPS course improved overall procedural sedation knowledge.