Sedation and Anesthesia in Pediatric and Congenital Cardiac Catheterization: A Prospective Multicenter Experience

C. Huie Lin, Sanyukta Desai, Ramzi Nicolas, Kimberlee Gauvreau, Susan Foerster, Anshuman Sharma, Laurie Armsby, Audrey C. Marshall, Kirsten Odegard, James DiNardo, Julie Vincent, Howaida El-Said, James Spaeth, Bryan Goldstein, Ralf Holzer, Jackie Kreutzer, David Balzer, Lisa Bergersen

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Sedation/anesthesia is critical to cardiac catheterization in the pediatric/congenital heart patient. We sought to identify current sedation/anesthesia practices, the serious adverse event rate related to airway, sedation, or anesthesia, and the rate of intra-procedural conversion from procedural sedation to the use of assisted ventilation or an artificial airway. Data from 13,611 patients who underwent catheterization at eight institutions were prospectively collected from 2007 to 2010. Ninety-four (0.69 %) serious sedation/airway-related adverse events occurred; events were more likely to occur in smaller patients (<4 kg, OR 4.4, 95 % CI 2.3–8.2, p < 0.001), patients with non-cardiac comorbidities (OR 1.7, 95 % CI 1.1–26, p < 0.01), and patients with low mixed venous oxygen saturation (OR 2.3, 95 % CI 1.4–3.6, p < 0.001). Nine thousand three hundred and seventy-nine (69 %) patients were initially managed with general endotracheal anesthesia, LMA, or tracheostomy, whereas 4232 (31 %) were managed with procedural sedation without an artificial airway, of which 75 (1.77 %) patients were converted to assisted ventilation/general anesthesia. Young age (<12 months, OR 5.2, 95 % CI 2.3–11.4, p < 0.001), higher-risk procedure (category 4, OR 10.1, 95 % CI 6.5–15.6, p < 0.001), and continuous pressor/inotrope requirement (OR 11.0, 95 % CI 8.6–14.0, p < 0.001) were independently associated with conversion. Cardiac catheterization in pediatric/congenital patients was associated with a low rate of serious sedation/airway-related adverse events. Smaller patients with non-cardiac comorbidities or low mixed venous oxygen saturation may be at higher risk. Patients under 1 year of age, undergoing high-risk procedures, or requiring continuous pressor/inotrope support may be at higher risk of requiring conversion from procedural sedation to assisted ventilation/general anesthesia.

Original languageEnglish (US)
Pages (from-to)1363-1375
Number of pages13
JournalPediatric Cardiology
Volume36
Issue number7
DOIs
StatePublished - Oct 21 2015
Externally publishedYes

Keywords

  • Anesthesia
  • Angioplasty
  • Catheterization
  • Congenital
  • Heart defects
  • Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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