Pediatric Deep Sedation for Ophthalmology Procedures in an Outpatient Setting, Risk Evaluation

Michael Russell Evans; Tonya Thompson; Christine Hsu; Beverly Spray; Lauren R Edwards; Adriana Grigorian; Abdallah Dalabih

doi:10.4103/aer.aer_134_21

Pediatric Deep Sedation for Ophthalmology Procedures in an Outpatient Setting, Risk Evaluation

Anesth Essays Res. 2021 Jul-Sep;15(3):301-305. doi: 10.4103/aer.aer_134_21. Epub 2022 Feb 14.

Authors

Michael Russell Evans¹, Tonya Thompson², Christine Hsu³, Beverly Spray⁴, Lauren R Edwards⁵, Adriana Grigorian⁶, Abdallah Dalabih⁷

Affiliations

¹ Department of Pediatric Sedation, Arkansas Children's Hospital, Little Rock, AR, USA.
² Section of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
³ College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
⁴ Arkansas Children's Research Institute, Little Rock, AR, USA.
⁵ Section of Critical Care Medicine, Children's Hospital and Medical Center Specialty Pediatric Center, Omaha, NE, USA.
⁶ Associate Professor of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
⁷ Associate Professor of Pediatrics, Section of Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Abstract

Background: Pediatric deep sedation (PDS) performed by a dedicated pediatric sedation service has been found to be safe, convenient, and efficient for minor procedures. Major complications such as cardiopulmonary resuscitation, intubation, and death are rare. However, minor complications such as desaturation, apnea, suctioning, or laryngospasm can occur infrequently. To date, little data exist evaluating PDS use for minor ophthalmology procedures.

Aims: The aim of this study was to evaluate the incidence of complications for subjects receiving PDS for minor ophthalmology procedures.

Setting: Pediatric children's hospital sedation service.

Materials and methods: This was a review of a prospectively collected database between 2018 and 2020. A hundred and thirty-four subjects aged 0-18 years, who underwent PDS for minor ophthalmology procedures, were compared to 1119 subjects who received PDS for other procedures (e.g., lumbar puncture, bone marrow aspirate/biopsy, and Botox).

Statistical analysis: SAS software, version 9.4, was used to determine variables associated with deep sedation that were predictive of complications. A multiple logistic regression procedure was conducted. Statistical significance was set at the 0.05 level.

Results: Subjects receiving PDS for ophthalmology procedures had a higher rate of minor complications than the control group (n = 18, 13.4%, vs. n = 58, 5.7%; P < 0001). No major complications occurred in any of the studied subjects. The ophthalmology group had a higher rate of bag-mask ventilation, airway positioning, and suctioning.

Conclusions: Ophthalmology procedures using PDS have a greater occurrence of minor complications compared to other painful procedures. No major complications were noted in either group, providing evidence that PDS can be performed safely for ophthalmology procedures using the sedation team model.

Keywords: Deep sedation; ophthalmology; pediatrics; propofol; safety.