Sedation and analgesia during procedures affecting children outside the operating room

Abstract

There are an increasing number of children requiring sedation and analgesia for invasive procedures, the majority of which are performed in the operating room (OR). 

Objectives: We prospectively studied the efficacy, safety and costs involved in the sedation and analgesia of different invasive procedures in children performed outside  the OR. Hypothesis: the use of short acting sedatives allows the performance of invasive procedures outside of the OR in a safe and cost effective manner. 

Patients and methods: We included children older than 1 month, outside of the ITU who required sedation for invasive procedures. Propofol was used alone or with other sedatives. Dose, side-effects, quality of sedation and cost were compared with that in the OR. 

Results: In 51 procedures carried out on 51 children, in 30/51 patients propofol was the only sedative used. The average total dose of propofol was 3.6 mg/kg, there were no differences in propofol dose when used alone or with other sedatives. The median recovery time was 20 min, range 4-45 min. Using a 1-10 scale, the quality of sedation was assessed, with a median of 10, range 7-10. 16 untoward  effects occurred in 13 patients, the commonest was respiratory depression in 8, these events were self limited and of short duration. The cost of the procedure was 6 times lower ($ 14 000) as compared to using the OR and recovery room ($ 90 000), and the overall time for the procedure performed was shorter 40 minutes vs 3 hours. 

Conclusions: the use of sedation and analgesia to permit the use of procedures outside the OR is safe and effective, decreasing costs and hospital time. Propofol was a good alternative as a sedative drug in these patients.