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Risk and safety of pediatric sedation/anesthesia for procedures outside the operating room

Cravero, Joseph P

Current Opinion in Anaesthesiology: August 2009 - Volume 22 - Issue 4 - p 509–513
doi: 10.1097/ACO.0b013e32832dba6e
Anesthesia outside the operating room: Edited by Alwin E. Goetz

Purpose of review Sedation and anesthesia outside the operating room represents a rapidly growing field of practice that involves a number of different specialty providers including anesthesiology. The literature surrounding this work is found in a variety of journals – many outside anesthesiology. This review is intended to inform readers about the current status of risk and safety involving sedation/anesthesia for tests and minor procedures utilizing a wide range of sources.

Recent findings Two large database studies have helped to define the frequency and nature of adverse events in pediatric sedation/anesthesia practice from a multispecialty perspective. A number of papers describing respiratory and hemodynamic aspects of dexmedetomidine sedation have also been published. Finally, a number of studies relating to training sedation providers, reporting of sedation adverse events, sedation for vulnerable populations, and (in particular) ketamine sedation adverse respiratory events have also come to light.

Summary The latest publications continue to document a relatively low risk to pediatric sedation yet also warn us about the potential adverse events in this field. The results help to define competencies required to deliver pediatric sedation and make this practice even safer. Particularly interesting are new jargon and methodologies for defining adverse events and the use of new methods for training sedation providers.

Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA

Correspondence to Joseph P. Cravero, Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA Tel: +1 603 650 6823; fax: +1 603 650 8980; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.