Abstract 14994: Sedation and Anesthesia Related Adverse Events in Pediatric and Congenital Cardiac Catheterization
Background: Sedation or anesthesia is critical to preparing the pediatric patient for cardiac catheterization, and procedural sedation with spontaneous respiration is often sufficient, however the threshold for general anesthesia is operator dependent. Diagnostic and interventional transcatheter procedures have evolved to increasingly complex procedures in increasingly complex patients. We sought to define the rate of use of procedural sedation versus general anesthesia in cardiac catheterization, the serious adverse event rate related to airway, sedation or anesthesia, and rate of intraprocedural conversion from procedural sedation to use of assisted ventilation or artificial airway.
Methods/Results:The Congenital Cardiac Catheterization Project on Outcomes (C3PO) has been prospectively collecting data on all catheterizations performed at eight pediatric institutions since 2007; 13,611 patients underwent catheterization from 2007 to 2010. 94 (0.69%) serious sedation/airway-related adverse events occurred; events were more likely to occur in smaller patients (<4kg OR 4.4, 95% CI 2.3-8.2, p<0.001), patients with non-cardiac co-morbidities (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). 9379 (69%) patients were managed with assisted ventilation/general anesthesia, whereas 4232 (31%) were managed with spontaneous respiration/procedural sedation, 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 inotrope requirement (OR 11.0, 95% CI 8.6-14.0, P<0.001) were independently associated with conversion.
Conclusions: Cardiac catheterization in pediatric and congenital patients was associated with a low rate of serious sedation/airway-related adverse events, however, patients who are smaller, have non-cardiac co-morbidities, or low mixed venous saturation may be at higher risk. Patients under one year of age, undergoing high risk procedures, or requiring inotropes may be at higher risk of requiring conversion from procedural sedation to assisted ventilation/general anesthesia.
- © 2012 by American Heart Association, Inc.