Identifying Post-Discharge Events in Pediatric Sedation Patients

Abstract

Purpose: To identify the incidence of parental-reported post-discharge events (PDEs) following moderate sedation and determine the sedation regimen and patient-specific factors that contribute to PDEs. Methods: Two thousand patient charts of pediatric patients who underwent sedation were screened. Information gathered from the patient record included patient body mass index (BMI), airway assessment, history of sleep-disordered breathing (SDB) symptoms, sedation medications and dosages, and parentally reported post-operative information. Results: Parents provided post-discharge information for 1,079 records (54 percent response rate). PDEs were reported for 35.2 percent of patients, with behavior issues (19.5 percent) and dental complications (17.6 percent) reported the most. Overall, more PDEs occurred in American Society of Anesthesiologists (ASA) I patients compared to ASA II patients (P<0.001) and increased as BMI increased (P=0.003) and tonsillar obstruction decreased (P=0.02). Comparing sedation regimens showed no difference in the proportion of PDEs (overall or by category; P>0.05). Patient age, ASA classification, height, BMI, Brodsky score, and sedation route influenced PDEs based on different sedation regimens and specific PDEs. Conclusions: Behavioral and dental issues are the most commonly parental-reported post-discharge events, and the rate of occurrence did not depend on the sedation regimen. The incidence of PDEs increased as body mass index increased, reinforcing the recommendation that obese patients should not sedated in the dental office, even if dosed to their lean body weight.