576 - Pediatric Procedural Sedation In Pediatric Oncology Patients: Does The Number Of Sedations Matter?

Poster Number: 576
Publication Number: 576.364

Background: Children diagnosed with childhood cancers are often recipients of many procedures including lumbar punctures (LPs), bone marrow aspirations (BMAs), and magnetic resonance imaging (MRI) scans throughout their treatment periods. Procedural sedation is a frequently utilized adjunctive modality to optimize patient compliance and successful procedure outcomes with some oncology research groups estimating that over 95% of LPs occur with concurrent procedural sedation. Despite the frequency with which procedural sedation is used, there is a paucity of data surrounding the impacts of repeated exposures to anesthetic or sedative medications.

Objective: The specific aim of this study was to evaluate the doses of sedation that patients received across multiple exposures to pediatric procedural sedation. A secondary aim included an examination of complication rates associated with repeated procedural sedations. We hypothesize that pediatric oncology patients who receive multiple sedations will require a larger dose of medication in subsequent sedations compared to the first sedation.

Design/Methods: We utilized a sedation registry maintained in Research Electronic Data Capture (REDCap) to examinehematology/oncology patients, ages 0-21 years, who received more than one procedural sedation by the sedation team between July 2018 and April 2022. For each procedural sedation occurrence, we recorded the duration of sedation, the types and doses of sedative medication utilized, as well as any complications attributed to sedation.

Results:

Over 1,300 patients were identified as receiving two or more procedures with concurrent procedural sedation. Statistical analysis using paired samples in patients who underwent more than 4 episodes of procedural sedation found that the medication dose utilized was significantly larger for the final sedation compared to the first sedation (p value of 0.001). There were 77 complications in total. Pearson’s Chi-squared analysis showed an increase in complications with fewer episodes of procedural sedation (p value of 0.017).


Conclusion(s): There was an increase in the dose of sedation utilized in patients who received more than 4 episodes of procedural sedation. Additionally, there were fewer complications in patients who received more than 4 episodes of procedural sedation. We presume that despite the increasing doses required with increasing sedation episodes, there are fewer adverse events due to identifying patients prone to complications in earlier sedation episodes.