Desaturation in procedural sedation for children with long bone fractures: Does weight status matter?

Am J Emerg Med. 2017 Aug;35(8):1060-1063. doi: 10.1016/j.ajem.2017.02.036. Epub 2017 Feb 20.

Abstract

Introduction: Childhood obesity remains a serious problem in the United States. Significant associated adverse incidents have been reported with sedation of children with obesity, namely hypoxemia. The objective of our study was to determine if overweight and obesity were associated with increased desaturations during procedural sedation compared with patients of healthy weight.

Methods: This was a single-center retrospective chart review of data from a three-year period of patient's age 2-17years. Of the 1700 charts reviewed 823 of these patients received procedural sedation and met the study inclusion criteria. Weight status was classified based on age and gender specific body mass index (BMI) percentiles: underweight, healthy weight, overweight, obese.

Results: Among all weight categories there was no statistical significance, however children with obesity had greater desaturation rates (9.9%) compared with children of underweight, healthy weight, or overweight combined (5.4%), χ2=4.46, p=0.035.

Discussion: The results indicate that children with obesity are almost twice as likely to have a desaturation related to procedural sedation compared with children of other weight status. Providers should be aware that children with obesity may be more likely to desaturate than other children, and therefore be skilled at recognizing this.

Keywords: Bone fracture; Obesity; Pediatrics; Sedation.

MeSH terms

  • Adolescent
  • Age Distribution
  • Body Mass Index
  • Capnography / statistics & numerical data
  • Child
  • Child, Preschool
  • Conscious Sedation* / adverse effects
  • Conscious Sedation* / methods
  • Dose-Response Relationship, Drug
  • Emergency Service, Hospital*
  • Female
  • Femoral Fractures / surgery*
  • Humans
  • Humeral Fractures / surgery*
  • Hypoxia / etiology
  • Hypoxia / prevention & control*
  • Male
  • Pediatric Obesity* / complications
  • Pediatric Obesity* / physiopathology
  • Practice Guidelines as Topic
  • Retrospective Studies
  • Tibial Fractures / surgery*
  • United States