LAUSR

Learning Objectives: Children frequently require procedural sedation for magnetic resonance imaging (MRI) or other procedures. Procedural sedation for the MRI studies is typically provided using natural airway deep sedation by an outpatient sedation team consisting of Pediatric Critical Care and Emergency Medicine physicians. Anesthesia literature has reported higher perioperative airway adverse events in children who have sleep disordered breathing (SDB). Currently no such information exists regarding children undergoing outpatient deep sedation without airway instrumentation. Further, no clear consensus exists in the sedation community as to when a referral to an anesthesiologist is warranted. We hypothesized that patients with a higher Apnea-Hypopnea Index (AHI), central apnea, or other comorbidities are more likely to require referral to an anesthesiologist. Methods: Retrospective chart review was completed of all patients with a positive polysomnogram who had an MRI either with deep sedation or general anesthesia (GA) from 2012-2017. Patient demographics, sleep study characteristics, and medications used were evaluated during the above period. Results: A total of 305 patients (sedation = 105, general anesthesia = 200) were evaluated. Median age for the sedation group was 5.5 (IQR 3.4-8.3). Median age for the general anesthesia group was 4.3 (IQR 2.4-7.8). 40/290 (25%) of total patients had severe snoring. Central apnea was present in 22/294 (12.1%) of patients referred to GA. The AHI was >10 in 40/186 (40%) of patients who received GA, and 94/104 (81.7%) of patients who underwent sedation had an AHI ≤ 4. 115/119 (96%) of the patients in the sedation group received propofol. Airway obstruction was noted in 16/119 (13.5%) with jaw thrust 18/119 (15.1%) being the most common intervention in the sedation group. Overall, patients with an AHI >10 were referred to general anesthesia, whereas those with AHI ≤ 4 were more likely to receive deep sedation with a natural airway. The AHI was higher in patients with increased severity of snoring. Conclusions: In this cohort, patients with AHI ≤ 4 appeared to do well on a pediatric sedation service. Patients with an AHI > 10 and central apnea were more likely to be referred for general anesthesia. In all cases, individual assessment to weigh the risks and benefits of sleep sedation versus general anesthesia is warranted.