Paediatric out-of-theatre procedural sedation at a tertiary children’s hospital: A prospective observational study

Abstract

Background. Red Cross War Memorial Children’s Hospital (RCWMCH) is one of the largest paediatric hospitals in Africa. Despite an increasing number of surgical and diagnostic procedures being performed annually, a formal out-of-theatre sedation service does not exist. Procedural sedation and analgesia (PSA) is an important adjunct in behavioural management for invasive procedures in children. 

Objective. A prospective, observational study was performed at RCWMCH, aimed primarily at defining the number of cases of PSA performed outside the operating theatre. 

Methods. Data were collected over a period of 3 months from all procedural out-of-theatre sedations performed, including ward patients and outpatient departments. All children <13 years of age were included. 

Results. A total of 639 sedations were performed. Of these sedations, 288 (45.1%) paper responses were captured and analysed. The reported incidence of airway obstruction was 4.9% (n=14/288), desaturation 4.2% (n=12/288), laryngospasm 0.3% (n=1/288) and nausea and vomiting 2.4% (n=7/288). Three cases required conversion to general anaesthesia, and four cases were abandoned as a result of inadequate sedation. In 16.3% (n=47/288) of cases, the clinician was an operator sedationist (the same person performing the sedation and the procedure). In 90.6% of cases, the intravenous route was utilised, with dexmedetomidine, ketamine and propofol being the three most commonly used agents. 

Conclusion. A total of 639 PSA events were recorded in 3 months. The 288 events analysed were safely performed with minimal serious reported events. These results compare favourably with international studies and provide quantitative evidence as a prelude to setting up a dedicated sedation service at RCWMCH.