• Thomas Riva, Fabio Pascolo, Markus Huber, Lorenz Theiler, Robert Greif, Nicola Disma, Alexander Fuchs, Joana Berger-Estilita, and Thomas Riedel.
• Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Unit for Research & Innovation in Anesthesia, Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genova, Italy. Electronic address: Thomas.riva@insel.ch.
• J Clin Anesth. 2022 May 1; 77: 110626.

Study ObjectiveTo investigate the variation of poorly ventilated lung units (i.e., silent spaces) in children undergoing procedural sedation in a day-hospital setting, until discharge home from the Post-Anesthesia Care Unit (PACU).DesignProspective, single-center, observational cohort trial.SettingThis study was conducted at the radiology department and in PACU at Bern University Hospital (Switzerland), a tertiary care hospital.PatientsWe included 25 children (1-6 years, ASA I-III) scheduled for cerebral magnetic resonance imaging scan, spontaneously breathing under deep sedation. Children planned for tracheal intubation, supraglottic airway insertion, or with contraindication for propofol were excluded.InterventionAfter intravenous or inhaled induction, deep sedation was performed with 10 mg/kg/h Propofol. All children received nasal oxygen 0.3 ml/kg/min.MeasurementsThe proportion of silent spaces and the global inhomogeneity index were determined at each of five procedural points, using electrical impedance tomography: before induction (T1); before (T2) and after (T3) magnetic resonance imaging; at the end of sedation before transport to the PACU (T4); and before hospital discharge (T5).Main ResultsThe median [interquartile range (IQR)] proportion of silent spaces at the five analysis points were: T1, 5% [2%-14%]; T2, 10% [7%-14%]; T3, 12% [5%-23%]; T4, 12% [7%-24%]; and T5, 3% [2%-11%]. These defined significant changes in silent spaces over the course of sedation (p = 0.009), but no differences in silent spaces from before induction to before discharge from the PACU (T1 vs. T5; p = 0.29). Median [IQR] global inhomogeneity indices were 0.57 [0.55-0.58], 0.56 [0.53-0.59], 0.56 [0.54-0.59], 0.57 [0.54-0.60] and 0.56 [0.54-0.57], respectively (p = 0.93). None of the children reported anesthesia-related complications.ConclusionDeep sedation results in significantly increased poorly ventilated lung units during sedation. However, this does not significantly affect ventilation homogeneity, which was fully resolved at discharge from the PACU.Trial Registrationclinicaltrials.gov, identifier NCT04507581.Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.

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