Format

Send to

Choose Destination
JAMA Pediatr. 2018 Jul 1;172(7):678-685. doi: 10.1001/jamapediatrics.2018.0830.

Association of Preprocedural Fasting With Outcomes of Emergency Department Sedation in Children.

Author information

1
Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
2
Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
3
Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
4
Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
5
Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
6
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
7
School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
8
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
9
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
10
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
11
Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
12
Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
13
Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
14
Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
15
Department of Pediatrics, University of Minnesota Medical School, Minneapolis.
16
Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis.

Erratum in

Abstract

Importance:

It is not clear whether adherence to preprocedural fasting guidelines prevent pulmonary aspiration and associated adverse outcomes during emergency department (ED) sedation of children.

Objective:

To examine the association between preprocedural fasting duration and the incidence of sedation-related adverse outcomes in a large sample of children.

Design, Setting, and Participants:

We conducted a planned secondary analysis of a multicenter prospective cohort study of children aged 0 to 18 years who received procedural sedation for a painful procedure in 6 Canadian pediatric EDs from July 2010 to February 2015. The primary risk factor was preprocedural fasting duration. Secondary risk factors were age, sex, American Society of Anesthesiologists classification, preprocedural and sedation medications, and procedure type.

Main Outcomes and Measures:

Four outcomes were examined: (1) pulmonary aspiration, (2) the occurrence of any adverse event, (3) serious adverse events, and (4) vomiting.

Results:

A total of 6183 children with a median age of 8.0 years (interquartile range, 4.0-12.0 years), of whom 6166 (99.7%) had healthy or mild systemic disease (American Society of Anesthesiologists levels I or II), were included in the analysis. Of these, 2974 (48.1%) and 310 (5.0%) children did not meet American Society of Anesthesiologists fasting guidelines for solids and liquids, respectively. There were no cases of pulmonary aspiration. There were 717 adverse events (11.6%; 95% CI, 10.8%-12.4%), of which 68 (1.1%; 95% CI, 0.9%-1.3%) were serious adverse events and 315 (5.1%; 95% CI, 4.6%-5.7%) were vomiting. The odds ratio (OR) of occurrence of any adverse event, serious adverse events, and vomiting did not change significantly with each additional hour of fasting duration for both solids (any adverse event: OR, 1.00; 95% CI, 0.98 to 1.02; serious adverse events, OR, 1.01; 95% CI, 0.95-1.07; vomiting: OR, 1.00; 95% CI, 0.97-1.03) and liquids (any adverse event: OR, 1.00; 95% CI, 0.98-1.02; serious adverse events: 1.01, 95% CI, 0.95-1.07; vomiting: OR, 1.00; 95% CI, 0.96-1.03).

Conclusions and Relevance:

In this study, there was no association between fasting duration and any type of adverse event. These findings do not support delaying sedation to meet established fasting guidelines.

Comment in

PMID:
29800944
PMCID:
PMC6137504
DOI:
10.1001/jamapediatrics.2018.0830
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center