RESUMO
BACKGROUND: Pediatric emergency department (ED) visits are common. Many are due to injury, which require procedural treatments with sedation. There are many well researched independent predictors of adverse events for pediatric procedural sedation. The duration of sedation as a predictor of adverse events has not been well studied. This study aims to determine the complication rate and severity of procedural sedation as well as determine if the duration of sedation is correlated with an increased risk of complications. METHODS: After Institutional Review Board approval, a retrospective study was performed on all patients seen at Helen Devos Children's ED who received sedation from August 1, 2011, to August 15, 2016. Study variables included age, weight, type of procedure, American Society of Anesthesiologist (ASA) physical status class, Mallampati score, comorbidities, sedation medication, sedation time, and complication. A logistic regression was performed assessing risk factors for complications. Statistical significance was assessed at P < 0.05. RESULTS: There were 1,814 patients included in the study. Median sedation time was 20 minutes. There were 70 (3.9%) total complications. Controlling for age, weight, comorbidities, ASA class, Mallampati score, and total sedation medication, sedation time was a significant predictor of a complication (odds ratio: 1.021; 95% CI, 1.004-1.039). CONCLUSIONS: Pediatric patients can safely undergo procedural sedation in the ED. This study demonstrates a high safety profile for long procedural sedations with slight increases in risk as sedation time increases. There is no identifiable time where the duration of sedation significantly increases the risk of complication.
RESUMO
Background: Carpal tunnel syndrome is a common cause of upper extremity discomfort. Surgical release of the median nerve can be performed under general or local anesthetic, with or without a tourniquet. Wide-awake carpal tunnel release (CTR) (local anesthesia, no sedation) is gaining popularity. Tourniquet discomfort is a reported downside. This study reviews outcomes in wide-awake CTR and compares tourniquet versus no tourniquet use. Methods: Wide-awake, open CTRs performed from February 2013 to April 2016 were retrospectively reviewed. Patients were divided into 2 cohorts: with and without tourniquet. Demographics, comorbidities, tobacco use, operative time, estimated blood loss, complications and outcomes were compared. Results: A total of 304 CTRs were performed on 246 patients. The majority of patients were male (88.5%), and the mean age was 59.9 years. One hundred patients (32.9%) were diabetic, and 92 patients (30.2%) were taking antithrombotics. Seventy-five patients (24.7%) were smokers. A forearm tourniquet was used for 90 CTRs (29.6%). Mean operative time was 24.97 minutes with a tourniquet and 21.69 minutes without. Estimated blood loss was 3.16 mL with a tourniquet and 4.25 mL without. All other analyzed outcomes were not statistically significant. Conclusion: Operative time was statistically longer and estimated blood loss was statistically less with tourniquet use, but these findings are not clinically significant. This suggests that local anesthetic with epinephrine is a safe and effective alternative to tourniquet use in CTR. The overall rate of complications was low, and there were no major differences in postoperative outcomes between groups.