Newman DH, Azer MM, Pitetti RD, et al. When is a patient safe for discharge after procedural sedation? The timing of adverse effect events in 1,367 pediatric procedural sedations. Ann Emerg Med 2003; 42:627-635.
After procedural sedation, children may be safely discharged 30 minutes after final sedation medication administration if no adverse events have occurred, according to this study from St. Luke’s/Roosevelt Hospital Center in New York City, Children’s Hospital of Pittsburgh, and the University of Pittsburgh Medical Center.
The researchers analyzed 1,341 sedation events, with 184 adverse effects, of which 159 were serious. Twenty-six sedation events were excluded because of subsequent patient hospitalization that was unrelated to the sedation event. Only patients discharged from the ED were included in the study.
Here are key findings:
- Most of the adverse effects occurred during the procedure, with only 8% occurring after the procedure.
- Serious adverse effects occurred a median of two minutes after final medication dose.
- One hypoxic episode occurred at 26, 30, and 40 minutes after final medication dose, but all these were repeated occurrences in children who had experienced previous hypoxia during the expected peak drug effect.
The study shows that the likelihood of delayed adverse effects in patients who have not had a previous adverse effect is extremely small, according to the researchers.
"Our data suggest that in children without serious adverse effects during procedural sedation and analgesia, discontinuation of monitoring and discharge from the ED may be safe approximately 30 minutes after final medication administration," they wrote.