Bacha T, Kejela S, Hagen SA. Establishing the first ever pediatric procedural sedation clinic in a low-income country: Assessment of the safety and efficacy. BMC Pediatr. 2025 Jan 31;25(1):85. doi: 10.1186/s12887-024-05351-4. PMID: 39891070; PMCID: PMC11783765.

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Abstract
Background: Pediatric sedation clinics are rare in low-income countries. Our aim is to describe the establishment of the first-ever pediatric sedation clinic in Ethiopia and provide an assessment of its safety and efficacy over the 5 years since its establishment.

Methods: A multi-phase approach was undertaken. In the first phase, we analyzed barriers to procedural pain management through repeated focus group discussions with stakeholders. Subsequently, we conducted a modified sedation provider course from the Society for Pediatric Sedation (SPS) with pre and post-training testing to document course effectiveness. Finally, we developed a procedural sedation clinic at Tikur Anbessa Specialized Hospital. In the second phase, we prospectively collected outcome data over a 5-year period from patients receiving procedural sedation at the clinic. This included assessing the efficacy of sedation and documenting any adverse events that occurred during the procedures.

Result: One hundred three providers completed the procedural sedation course. There was a 13.4% improvement in knowledge between baseline and post-course testing. A total of 2,820 patients underwent procedural sedation over the 5-year period from 2016 through 2021, and data selected from 475 (16.8%) patients were analyzed. The most common procedure performed was bone marrow aspiration/biopsy in 384 subjects (80.8%). The most common procedural sedation used was the combination of ketamine and propofol in 60.6%. The mean pain score during the procedure was 0.28/10, which was significantly lower than the pre-procedural pain score (p-value < 0.001). A total of 9 (1.9%) patients had adverse events and there was no mortality.

Conclusion: Based on our experience, development of a safe and effective sedation clinic is possible in resource-limited settings as evidenced by low procedural pain scores, and low adverse events rates. Provider training based on a modification of the SPS course improved overall procedural sedation knowledge.

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Cohen N, Levy N, Koppel JH, Alkoby-Meshulam L, Friedman N, Test G, Buchshtav N, Weiser G, Klein A, Chistyakov I, Shavit I; Israel Pediatric Emergency Research Network (ISPERN). Dissociative and Deep Sedations Administered by Trained Unsupervised Pediatric Residents in Israeli Emergency Departments. Ann Emerg Med. 2025 Jan 22:S0196-0644(24)01301-5. doi: 10.1016/j.annemergmed.2024.12.020. Epub ahead of print. PMID: 39846905.

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Abstract
Study objective: To cover pediatric emergency physicians’ off-hours, third-year pediatric residents in Israel are trained for unsupervised administration of emergency department (ED) dissociative and deep sedation. We assessed the frequency of critical sedation events associated with resident-performed sedations.

Methods: We conducted a retrospective chart review on all patients receiving intravenous sedation across 10 pediatric EDs between January 2018 and September 2022. We defined a critical sedation event as one or more of the following: chest compressions, tracheal intubation, neuromuscular blockers, vasopressors, atropine for bradycardia, aspiration syndrome, death, or unplanned hospital admission due to sedation. We liaised with the Ministry of Health’s reporting department and ED directors to verify complete identification of all sentinel events.

Results: Pediatric residents and pediatric emergency physicians performed 12,733 and 10,845 sedations, respectively, most frequently for fracture reduction (44.4%) and laceration repair (25.6%). Patients’ mean (SD) age was 6.9 (4.4) years. Residents and emergency physicians administered ketamine or propofol alone in 6,473 and 3,465 cases, respectively, with drug combinations for the remainder. We identified 6 critical sedation events, of which 3 were resident-performed sedations. The frequency of critical sedation events among pediatric residents and emergency physicians was 0.024% (95% CI, 0.005% to 0.069%) and 0.028% (95% CI, 0.006% to 0.080%), respectively.

Conclusion: We observed a low frequency of critical sedation events in this large sample of dissociative and deep sedations performed by pediatric residents and pediatric emergency physicians. Our findings suggest that ED sedation by unsupervised, trained pediatric residents is a safe practice in Israel.

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Yan C, Sun X, Sun Y, Zuo M, Hua Z. Clinical application and progress in preoxygenation techniques. Minerva Anestesiol. 2024 Dec 10. doi: 10.23736/S0375-9393.24.18355-1. Epub ahead of print. PMID: 39656146.

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Abstract
Introduction: Airway management is often a life-saving procedure for patients. However, during airway management, difficult ventilation and difficult intubation are not always predictable. Preoxygenation, a crucial technique to improve oxygen reserves, plays a vital role in preventing hypoxemia during anesthesia induction. Preoxygenation technology and equipment are not monolithic. With the development of preoxygenation equipment and technology, the effect of preoxygenation has been improved, and it can be applied to different clinical settings.

Evidence acquisition: We conducted a literature search (PubMed and Scopus) in October 2023 with a starting date of January 1985, repeated in August 2024, to identify relevant articles. Key search terms included: ‘preoxygenation,’ ‘high-flow nasal oxygenation,’ ‘non-invasive ventilation,’ ‘obese patients,’ ‘pediatric patients,’ and ‘elderly patients.’

Evidence synthesis: The abstracts of identified articles were assessed for relevance, along with screening of their references for further relevant publications. A full-text review of 219 articles was undertaken, of which 77 were included in the final review.

Conclusions: Preoxygenation is really effective, and different preoxygenation equipment and technology can be applied in different clinical settings to improve the oxygen reserve of patients, thereby ensuring patient safety and improving patient outcome.