Presented by Melissa Patel, MD; Benjamin Jackson, MD; and James Hertzog, MD
This presentation was divided into three sections focusing on three types of factors:
- Patient,
- Procedure, and
- Provider.
Each presenter highlighted one of the factors.
Patient factors – Dr. Patel started by reviewing definitions of adverse events and the continued variation in these. Patient factors such as age (particularly less than one to two years), obesity (especially associated with snoring) and upper respiratory infection were the major factors discussed. The importance of obtaining accurate information from parents by asking the right questions to determine the severity of these conditions was emphasized. Other considerations that warrant further investigation such as prematurity, craniofacial anomalies, increased ICP and congenital heart disease/pulmonary hypertension were discussed.
Procedure factors – Pre-screening is one of the things that matters most before a procedure. Dr. Hertzog noted that there is little evidence to provide specific guidance on risk associated with specific procedures or when procedures are combined. However, there is some evidence associating bronchoscopy with adverse events, while painful procedures have been associated with fewer adverse events.
Provider factors – Dr. Jackson discussed that, in procedural sedation, training, clinical practice and location are all important considerations. For example, there is little data on differences in single provider versus separate provider sedation; however, if the provider is in a location such as the emergency department or pediatric ICU where they are also responsible for other patients, this may have to be considered in addition to the provider and team’s skill. Organizational infrastructure and back-up planning are necessary to maintain safety.
