564 - Dexmedetomidine vs Propofol Induction for Sedated Radiologic Procedures in Patients with Trisomy 21

Publication Number: 2549.564

Carmen Sulton, Emory University School of Medicine, DECATUR, GA, United States; Carlos A.. Delgado, PEMA/ Children's Healthcare of Atlanta, Suwanee, GA, United States; David H. Fagin, PEMA - - Atlanta, GA, Roswell, GA, United States; Jaimee S. Holbrook, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, Chicago, IL, United States; Hwanseok Winston. Choi, Morehouse School of Medicine, Atlanta, GA, United States; Rebecca K. Burger, Emory University School of Medicine, Atlanta, GA, United States; Austin Chan, Morehouse School of Medicine, Atlanta, GA, United States

Background: Patients with Trisomy 21 (T21) are more susceptible to sedation-related adverse events (AEs) due to their hypotonia and larger tongues. Despite literature focused on the airway risks associated with general anesthesia, there is a paucity of literature addressing natural airway sedation procedures in these patients. Very few studies address the risk of propofol, which has increased risk of apnea and airway obstruction, or which compare sedation regimens in this high-risk population. Studies indicate that dexmedetomidine (DEX) is less likely than propofol to result in AEs as it promotes less airway muscle relaxation than propofol.

Objective: To analyze the number of patients with T21 as their primary or secondary diagnosis undergoing sedated radiologic procedures. We will analyze T21 patients undergoing induction of sedation with DEX compared with propofol who have critical/high risk events and low risk events. Our working hypothesis is induction with DEX will have fewer critical or high events and fewer low risk events compared with propofol.

Design/Methods: This study is a secondary analysis of prospectively collected data. We queried the Pediatric Sedation Research Consortium (PSRC) Database from the years 2020-2025. The demographic characteristics were summarized using descriptive statistics. The incidence of sedation-related AEs and sedation failures were described by induction drug (DEX vs propofol) using frequencies and percentages. Any medication used other than DEX or Propofol were excluded. We performed a propensity score analysis comparing the DEX cohort to the propofol cohort. The covariates of interest include obesity, snoring, upper airway abnormality, and upper respiratory infection. All the statistical work was performed using SAS 9.4.

Results: A total of 337 patients met the inclusion criteria. 62% were male and the average age was 7 years. 44% of AEs were partial airway obstruction. There were no serious AEs reported. Induction with propofol had a 5 times higher odds of an AE (OR = 5.069, 95%: 2.829 - 9.082). After propensity score matching, there are a total of 216 matched observations left in the dataset. We found that the odds of an AEs were 4.4 times higher with propofol induction compared to DEX, which was concordant with the bivariate analysis.

Conclusion(s): In patients with T21 undergoing radiologic procedures, the odds of having any AE are higher with induction using propofol compared to DEX. Consideration should be given for use of DEX induction for patients with T21 undergoing sedated radiologic procedures.

Demographic Data
We performed a descriptive analyses to summarize demographic characteristics. The demographic variables are gender and age (months). The incidence of sedation-related AEs is also described using frequencies and percentages. All statistical work was done using SAS 9.4.

.Bivariate analyses between outcome variable (adverse events) and other variables
Based on the results above, the AE (outcome variable) is statistically significant (χ2df = 1 = 33.249, p < .001). Induction with propofol had a 5 times higher odds of an AE (OR = 5.069, 95%: 2.829 - 9.082). The age of the participant is also statistically significant (t = 8.19, p < .001).

Generalized estimating equation model results using the propensity score matched data
After the propensity score matching, there are a total of 216 matched observations left in the dataset. We used a greedy nearest neighbor matching. Propensity score matching was performed by SAS 9.4.
From the above, we found that the odds of an AE are around 4.4 times higher with propofol than with DEX, which was concordant with bivariate analysis results.