Background:
Propofol is widely used to sedate children for radiological procedures. Because propofol is an anesthetic, its use in the past was restricted to anesthesiologists. The hospitalist group at St. Louis Children's Hospital (SLCH) successfully performed more than 1600 propofol sedations between 2005 and 2009. A chart review of patients sedated with propofol over that period showed that the rate of adverse events such as apnea, obstruction, desaturation, and need for airway interventions was 9.8%. However, that rate dropped from 11% in 2005 to 2.3% in 2009. Our goal was to identify risk factors and patient characteristics that changed between 2005 and 2009 and that contributed to the decreased rate of events.
Methods:
The CPT code for deep sedation was used to identify all patients (n = 1649) sedated by hospitalists from January 2005 through September 2009 at SLCH. Charts were reviewed to determine factors associated with an increased likelihood of adverse events. Odds ratios (ORs) with 95% confidence intervals were calculated by comparing the likelihood of events in a given group to that of the entire patient population.
Results:
Several factors contributed to a decreased likelihood of adverse events in the period from 2005 to 2009. The percentage of patients in American Society of Anesthesiology (ASA) category 3 decreased from 10% to 2%, whereas those in ASA category 1 increased from 25% to 50%. ASA 3 patients had an increased likelihood of events, with an OR of 1.6 (0.96–2.6), whereas ASA 1 patients had a lower likelihood, with an OR of 0.66 (0.45–0.99). Premedication with oral Versed was significantly associated with events, with an OR of 1.6 (1.2–2.3); its use decreased from 41% to 3.3% of patients between 2005 and 2009. Likewise, patients given Robinul to control secretions had a higher likelihood of events, with an OR of 8.0 (2.7–24); its use decreased from 5.6% to 3.2% of patients. Occurrence of events was significantly higher in patients > 12 years: OR, 3.9 (2.4–6.3). The fraction of this patient population dropped 2‐fold from 8.0% to 3.8% over that period. Additional risk factors for events were identified, but they did not change in frequency over that period: a history of snoring, with an OR of 2.5 (1.8–3.5), and coughing during the procedure, with an OR of 50 (22–116).
Conclusions:
The safety of propofol sedations can be improved by identification and reduction of risk factors. Patient characteristics associated with adverse events are ASA 3 and age > 12 years, whereas ASA 1 patients have fewer events. Procedurally, premedication with oral Versed and the use of Robinul to control secretions predispose to adverse events. Appropriate patient selection and cautious use of adjuvant medications significantly improves patient safety during propofol sedation performed by a hospitalist group.
Disclosures:
M. Srinivasan ‐ none; L. Depalma ‐ none; M. Turmelle ‐ none; J. Mao ‐ none; D. Carlson ‐ none