Outpatient procedural sedation over the past decade has been evolving with hospitalists joining anesthesiologists to do the sedating, as well as changes in the types of agents being used over this period of time. To look more closely at these trends, Kamat et al (10.1542/peds.2019-3559) analyzed data collected by the Pediatric Sedation Research Consortium, a voluntary group of clinicians from around the country who report their data on sedation given outside of the operating room (OR).
The authors looked at 3 four-year epochs ranging from 2007 to 2018 involving over 430,000 outpatient sedation encounters. In line with what we are discovering regarding the association of possible CNS vulnerability with early use of some anesthetic agents, particularly general anesthesia, there has been a decrease in infants under 3 months of age getting procedural sedation, perhaps due to delaying these procedures until an infant is older and less at risk for adverse neurologic complications. The authors also point out a decrease in the use of chloral hydrate and pentobarbital and a significantly increase in the use of dexmedetomidine.
There was a rise in the number of pediatric hospitalists doing sedation and no increase in overall serious adverse events associated with procedural sedation. Although implied, we cannot determine directly whether it is safe to have pediatric hospitalists providing sedation. In a commentary to this article written by Drs. Toney, Pattishall and Garber from Wolfson Children’s Hospital in Jacksonville Florida (10.1542/peds.2020-0446), limitations of the large database used by Kamat et al is described, such as the self-selection of respondents. They also raise concerns that with whether fellowship training for hospitalists offers sufficient opportunity for becoming proficient at procedures. There is plenty more data that will keep you wide-awake—and certainly not sedated—so check out both this study and commentary and see if the trends reported parallel those in your local pediatric inpatient facility.
