Children with and without developmental disabilities: Sedation medication requirements and adverse events related to sedation

OBJECTIVE: Our objective was to prospectively compare sedation medication requirements and adverse events related to sedation in children with and without developmental disabilities. METHODS: We conducted a prospective, observational, age-matched, 1:2 case-control study of children (3-10 years) sedated for brain magnetic resonance imaging at a tertiary-care children's hospital. Developmental assessment was performed using the Vineland Adaptive Behavioral Scale and by a pediatric neurologist. Patients were sedated according to institutional sedation protocol. Patient demographics, type and dose of sedation medications, depth of sedation, and adverse events were collected. We defined hypoxia as oxygen saturation 90% or less for 30 seconds or longer and requiring airway maneuvers. RESULTS: Seventy children were designated as cases (DD) and 140 as controls (DN). DD had a significantly lower mean Vineland Adaptive Behavioral Scale score than did DN (DD: 62.34 ± 9.70, DN: 103.0 ± 13.71; P < 0.001). A combination of pentobarbital and fentanyl (DD: 32/70 [45.7%], DN: 60/140 [42.9%]) and combination of pentobarbital and midazolam (DD: 28/70 [40%], DN: 43/140 [30.7%]) were the most common sedatives used in both groups. There was no difference in the mean dose of pentobarbital (DD:4.68 ± 1.63 mg/kg, DN:4.67 ± 1.69 mg/kg; P = 0.9), fentanyl (DD: 0.61 ± 0.65 μg/kg, DN: 0.64 ± 0.65 μg/kg; P = 0.7), and midazolam (DD: 0.15 ± 0.17 mg/kg, DN: 0.11 ± 0.14 mg/kg; P = 0.1). There was no difference in the overall adverse events (DD: 30%, DN: 32.9%; P = 0.7) as well as hypoxia (DD: 10%; DN: 9.3%, P = 0.9). CONCLUSIONS: When compared with DN children, DD children do not require a higher dose of sedatives and do not have a higher incidence of adverse events.