Nighttime Sedations in the Pediatric Emergency Department: A Single-Center Experience.

Introduction: Procedural sedation and analgesia (PSA) is the standard of care for many procedures in the pediatric emergency department (PED). Although generally performed by skilled PED physicians, in Israeli PEDs, during nighttime hours, it is mainly performed by pediatric residents. The safety of PSA by residents is considered comparable yet has not been evaluated regarding nighttime performance.

Methods: A retrospective study review of PSA performed in the PED at night (1:00 a . m .-7:00 a . m .). To evaluate these events, we compared each case of nighttime PSA to 2 daytime PSA cases from 2017 to 2019. Adverse events were evaluated using the Quebec criteria.

Results: The study included 451 sedations performed on 438 children from January 2017 to January 2019. Adverse events (AEs) occurred in 29 (6.4%) of the sedations. Serious AEs were uncommon. This included mostly bag-valve-mask ventilation used in 13 (2.9%) of the cases. Of these, 12 were daytime sedations. There was a clear association between abscess drainage during daytime hours and AEs.

Conclusions: Sedations performed during nighttime hours by pediatric residents seem safe and effective. This should strengthen the empowerment of residents to perform sedations when necessary even at late hours of the night. Recognizing cases at higher risk may avoid possible AEs.