595 - Factors associated with vomiting and pulmonary aspiration during and after procedural sedation in children: a report from the pediatric Sedation Research Consortium

Publication Number: 1572.595

Naveen Poonai, The University of Western Ontario - Schulich School of Medicine & Dentistry, Dorchester, ON, Canada; Ewa Sucha, CHEO, Ottawa, ON, Canada; Nick Barrowman, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada; Maala Bhatt, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Daniel S. Tsze, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Rebecca K. Burger, Emory University School of Medicine, Atlanta, GA, United States

Background: In children undergoing procedural sedation, it is well established that adherence to American Society of Anesthesiologists (ASA) nil per os (NPO) fasting guidelines is not associated with pulmonary aspiration, but it is unknown whether adherence to ASA NPO guidelines is associated with a lower risk of vomiting.

Objective: To determine if adherence to American Society of Anesthesiologists nil per os (ASA NPO) guidelines is associated with a lower risk of vomiting during and following procedural sedation and to determine other factors associated with vomiting.

Design/Methods: Secondary analysis of prospectively collected data from 64 institutions contributing to the Pediatric Sedation Research Consortium database (April 27, 2020 - October 31, 2024). Primary outcome was vomiting. We explored the relationship between ASA NPO status and vomiting in a multivariable model adjusting for age, sex, procedure, ASA class, ASA NPO status, obesity, sedative, ketamine by route of administration, pre-induction, induction and maintenance opioids, pre-induction ondansetron, and site as a random effect.

Results: We included 146,652 sedation encounters with a median (IQR) age of 5 (2,10) years. ASA NPO guidelines were adhered to in 134,479/146,652 (91.7%) sedations. Vomiting was reported in 277/146,652 (0.2%) sedations. The most common sedatives were propofol (117,385/146,652; 80.0%) and midazolam (20,762/146,762; 14%), while pre-induction ondansetron was infrequent (3,093/146,652; 2.1%). In the adjusted analysis, adherence to ASA NPO guidelines was not found to be associated with vomiting (OR:1.10; 95%CI:0.63,1.89). Factors associated with vomiting were intramuscular (OR:14.1; 95%CI:8.69,23) and non-intramuscular ketamine (OR:3.49; 95%CI: 2.35, 5.27), N2O (OR:8.93; 95%CI:5.46,14.6), obesity (OR:1.54; 95%CI:1.15,2.06) and age (OR:1.08 per additional year; 95%CI:1.05,1.1). Pre-induction, induction, and maintenance opioids were associated with a lower odds of vomiting (OR:0.51; 95%CI:0.32,0.8). There were eight cases of pulmonary aspiration, of which all but one met fasting guidelines.

Conclusion(s): There was no association between adherence to ASA NPO guidelines and vomiting in this sample of primarily propofol and midazolam sedations. Clinicians should consider choice of sedative and patient-specific factors rather than fasting status to provide anticipatory guidance and prepare for vomiting.

Figure 1. Adjusted Analysis of Factors Associated with Vomiting in Children Undergoing Procedural Sedation
PAS Figure 1.pdf