Agitation During Procedural Sedation and Analgesia in Children

Background. Agitation that occurs in children receiving standard procedural sedation regimens may indicate inadequate patient comfort and compromise procedural success. Although agitation in uninterrupted pediatric procedures is recognized to occur, it is not generally tracked as an adverse event, and there have been no formal studies to determine its rate of incidence. Methods. We identified intraprocedural agitation in a large cohort of children undergoing standardized sedation regimens in a tertiary care pediatric hospital over a calendar year and compared it with rates of well-accepted quality measures of sedation using odds ratio analysis, with 95% confidence intervals (CIs). All analyses excluded those patients who were documented to fail to sedate or to wake before the procedure was over-2 tracked adverse events that involve agitation and aborted, interrupted, or incomplete procedures. Results. Agitation occurred in 433 of 5045 (8.6%) procedures during the study period, including 306 (6.1%) who had an uninterrupted, complete procedure. In contrast, severe adverse events during sedation, including cardiovascular resuscitation and allergic reactions, were exceedingly rare (0.9%). When excluding patients who woke during the procedure or who failed to sedate, we found that the odds ratio for the association between agitation and tracked adverse events was 2.9 (95% CI = 1.7-4.8; P < .001). Discussion. A clinically significant number of children appear agitated during standard procedural sedation and analgesia. In addition, agitation in children undergoing uninterrupted procedures was associated with other adverse events. Identifying risk factors for agitation is fundamental to improving the quality of procedural sedation in children.