• Jocelyn R Grunwell, Neelima K Marupudi, Rohan V Gupta, Curtis D Travers, Courtney E McCracken, Julie L Williamson, Jana A Stockwell, James D Fortenberry, Kevin Couloures, Joseph Cravero, and Pradip P Kamat.
• Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.
• Paediatr Anaesth. 2016 Jun 1; 26 (6): 628-36.

Background/AimsGuidelines for referral of children to general anesthesia (GA) to complete MRI studies are lacking. We devised a pediatric procedural sedation guide to determine whether a pediatric procedural sedation guide would decrease serious adverse events and decrease failed sedations requiring rescheduling with GA.MethodsWe constructed a consensus-based sedation guide by combining a retrospective review of reasons for referral of children to GA (n = 221) with published risk factors associated with the inability to complete the MRI study with sedation. An interrupted time series analysis of 11 530 local sedation records from the Pediatric Sedation Research Consortium between July 2008 and March 2013, adjusted for case-mix differences in the pre- and postsedation guide cohorts, evaluated whether a sedation guide resulted in decreased severe adverse events (SAE) and failed sedation rates.ResultsA significant increase in referrals to GA following implementation of a sedation guide occurred (P < 0.001), and fewer children with an ASA-PS class ≥III were sedated using procedural sedation (P < 0.001). There was no decrease in SAE (P = 0.874) or in SAE plus airway obstruction with concurrent hypoxia (P = 0.435). There was no change in the percentage of failed sedations (P = 0.169).ConclusionsMore studies are needed to determine the impact of a sedation guide on pediatric procedural sedation services.© 2016 John Wiley & Sons Ltd.

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