In another study, a small observational chart review performed by Elwood et al.
suggests that the anteroposterior oropharyngeal airway diameter was smaller in children with developmental delay than in those without developmental delay, in static MRI images .
Unfortunately, extensive studies have not been performed to identify specific patients at risk and aid in the development of evidence-based clinical protocols for patients with neurologic pathology and developmental disabilities.
has an excellent review of sedation complications related to many specific syndromes ).
So what are the actual added risks associated with sedation of the pediatric patient with developmental disabilities or neurologic disorders?
In this study, the most common diagnosis for the cause of developmental disability was autism (36%).
In addition, the authors included patients with attention deficit hyperactivity disorder (20%) as a diagnosis for developmental disability.
Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA 19129, USAReceived 2 December 2009; Revised 15 June 2010; Accepted 20 June 2010Academic Editor: Savithiri Ratnapalan Copyright © 2010 Todd J. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sedation and analgesia performed by the pediatrician and pediatric subspecialists are becoming increasingly common for diagnostic and therapeutic purposes in children with developmental disabilities and neurologic disorders (autism, epilepsy, stroke, obstructive hydrocephalus, traumatic brain injury, intracranial hemorrhage, and hypoxic-ischemic encephalopathy).
Search terms included “sedation”, and “analgesia”, “pediatric”, “child”, “neonate”, “brain”, “developmental disabilities”, “neurologic”, “autism”, “epilepsy”, “seizure”, “stroke”, “hydrocephalus”, “traumatic brain injury”, “intracranial hemorrhage”, “hypoxia-ischemia”, and “encephalopathy” and the period of search was from 1960–2010.
The authors are pediatric neurocritical care specialists and have extensive clinical experience caring for pediatric patients with developmental disabilities and neurologic disorders and research experience in experimental animal models of pediatric neurologic injury.
This database has provided vital information to define the frequency and nature of adverse events during pediatric sedation from a multispecialty perspective .
Large PSRC studies have shown a relatively low risk to pediatric sedation by practitioners other than anesthesiologists .
In subsequent analysis, factors that related to higher rates of pulmonary complications were young patients, use of adjunctive opiates, and patients with a higher American Society of Anesthesiology (ASA) status (≥III), a large proportion with neurologic conditions .