(2) Investigating the Safety of Outpatient Sedation in Pediatric Oral and Maxillofacial Surgery at an Urban Academic Center

Abstract: In recent years, several high-profile adverse events which occurred during outpatient sedation procedures in oral and maxillofacial surgery (OMS) practices have resulted in increased scrutiny on the use of outpatient sedations in OMS. Several high-quality studies have re-affirmed the consistent safety of the OMS outpatient anesthesia model; however, these studies have largely assessed outcomes for adult patients, with limited attention directed towards the pediatric population(1). This study seeks to address that deficiency by investigating the safety of OMS outpatient sedation in the pediatric population.
This study involved a retrospective analysis of outpatient sedation data from January 2017 to February 2023 performed in the oral and maxillofacial surgery clinic at a large academic center (Bellevue Hospital Center). Data in the form of demographics, health history, procedures, medications, adverse events, and management of adverse events was reviewed for this study. Inclusion criteria for the study were as follows: age < 18 y/o, presence of complete records detailing procedures, medications, and presence/absence of adverse events. Exclusion criteria were as follows: age >= 18 y/o or incomplete records of procedure or medications. 370 patient records met the criteria for inclusion in the study. Data analysis was performed with SAS 9.4. Relationships involving categorical and continuous variables were analyzed via chi-square, Fischer exact tests, student t-test, and ANOVA, as appropriate.
The results of this retrospective study revealed that adverse events (AEs) encountered during outpatient sedation of pediatric patients in the OMS clinic were quite uncommon with a frequency of 2.1%. Moreover, all adverse events (AEs) were of minimal risk according to the World SIVA Adverse Sedation Event Reporting tool(2). AEs encountered in this study included 1 case of subclinical respiratory depression, 2 cases of post-operative emesis and 5 cases of agitation. No statistically significant relationships were found between demographics, health history or medications and the incidence of AEs.
In conclusion, outpatient sedations performed by oral and maxillofacial surgeons for pediatric patients is safe and effective, with few adverse events. In light of the dearth of studies assessing outcomes in the pediatric population for OMS outpatient sedation; this author recommends more comprehensive studies looking at this area.

1. Wiemer SJ, Nathan JM, Heggestad BT, et al. Safety of Outpatient Procedural Sedation Administered by Oral and Maxillofacial Surgeons: The Mayo Clinic Experience in 17,634 Sedations (2004 to 2019). J Oral Maxillofac Surg. 2021;79(5):990-999. doi:10.1016/j.joms.2020.12.002
2. Mason KP, Green SM, Piacevoli Q. Adverse event reporting tool to standardize the reporting and tracking of adverse events during procedural sedation: A consensus document from the World SIVA International Sedation Task Force. Br J Anaesth. 2012;108(1):13-20. doi:10.1093/bja/aer407