Abstract
Background
Fasting guidelines for pediatric procedural sedation have historically been controversial.
Recent literature suggests that there is no difference in adverse events regardless
of fasting status.
Objectives
The goal of this study was to examine adverse outcomes and departmental efficiency
when fasting guidelines are not considered during pediatric emergency department (PED)
sedation for orthopedic interventions.
Methods
Retrospective chart review identified 2674 patients who presented to a level I PED
and required procedural sedation for orthopedic injuries between February 2011 and
July 2018. This was a level III, retrospective cohort study. Patients were categorized
into the following groups: already within American Society of Anesthesiologists (ASA)
fasting guidelines on presentation to the PED (n = 671 [25%]), had procedural sedation
not within the ASA guidelines (n = 555 [21%]), and had procedural sedation after fasting
in the PED to meet ASA guidelines (n = 1448 [54%]). Primary outcomes were length of
stay, time from admission to start of sedation, length of sedation, time from end
of sedation to discharge, and adverse events.
Discussion
There was a significant difference in the length of stay and time from admission to
sedation—both approximately 80 min longer in those with procedural sedation after
fasting in the PED to meet ASA guidelines (p < 0.001). There was no significant difference among groups in length of sedation
or time to discharge after sedation. Adverse events were uncommon, with only 55 total
adverse events (0.02%). Vomiting during the recovery phase was the most common (n = 17
[0.006%]). Other notable adverse events included nine hypoxic events (0.003%) and
five seizures (0.002%). There was no significant difference in adverse events among
the groups.
Conclusions
Length of stay in the PED was significantly longer if ASA fasting guidelines were
followed for children requiring sedation for orthopedic procedures. This is a substantial
delay in a busy PED where beds and resources are at a premium. Although providing
similar care with equivalent outcomes, the value of spending less time in the PED
is evident. Overall, adverse events related to sedation are rare and not related to
fasting guidelines.
Keywords
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References
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Article info
Publication history
Published online: December 12, 2020
Accepted:
October 19,
2020
Received in revised form:
October 10,
2020
Received:
June 27,
2020
Footnotes
Dr. Kelly discloses publishing royalties from Elsevier and Dr. Sawyer has received payment for presentations from Nuvasive and Republic Spine in addition to publishing royalties from Elsevier and Wolters-Kluwer.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
