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{
    "pk": 11102,
    "title": "Higher Mallampati Scores Are Not Associated with More Adverse Events During Pediatric Procedural Sedation and Analgesia",
    "subtitle": null,
    "abstract": "Introduction:\n Procedural sedation and analgesia (PSA) is used by non-anesthesiologists (NAs) outside of the operating room for several types of procedures. Adverse events during pediatric PSA that pose the most risk to patient safety involve airway compromise. Higher Mallampati scores may indirectly indicate children at risk for airway compromise. Medical governing bodies have proposed guidelines for PSA performed by NAs, but these recommendations rarely suggest using Mallampati scores in pre-PSA evaluations. Our objective was to compare rates of adverse events during pediatric PSA in children with Mallampati scores of III/IV vs. scores of Mallampati I/II. \nMethods:\n This was a prospective, observational study. Children 18 years of age and under who presented to the pediatric emergency department (PED) and required PSA were enrolled. We obtained Mallampati scores as part of pre-PSA assessments. We defined adverse events as oxygen desaturation < 90%, apnea, laryngospasm, bag-valve-mask ventilation performed, repositioning of patient, emesis, and “other.” We used chi-square analysis to compare rates of adverse events between groups. \nResults: \nWe enrolled 575 patients. The median age of the patients was 6.0 years (interquartile range = 3.1,9.9). The primary reasons for PSA was fracture reduction (n=265, 46.1%). Most sedations involved the use of ketamine (n= 568, 98.8%). Patients with Mallampati scores of III/IV were more likely to need repositioning compared to those with Mallampati scores of I/II (p=0.049). Overall, patients with Mallampati III/IV scores did not experience a higher proportion of adverse events compared to those with Mallampati scores of I/II. The relative risk of any adverse event in patients with Mallampati scores of III/IV (40 [23.8%]) compared to patients with Mallampati scores of I/II (53 [18.3%]) was 1.3 (95% confidence interval [0.91-1.87]).\nConclusion:\n Patients with Mallampati scores of III/IV vs. Mallampati scores of I/II are not at an increased risk of adverse events during pediatric PSA. However, patients with Mallampati III/IV scores showed an increased need for repositioning, suggesting that the sedating physician should be vigilant when performing PSA in children with higher Mallampati scores.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "pediatric procedural sedation and analgesia, Mallampati, adverse events"
        }
    ],
    "section": "Critical Care",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/5qk5b7k2",
    "frozenauthors": [
        {
            "first_name": "Maya",
            "middle_name": "S.",
            "last_name": "Iyer",
            "name_suffix": "",
            "institution": "The Ohio State University College of Medicine/Nationwide Children’s Hospital, Department of Pediatrics, Section of Emergency Medicine, Columbus, Ohio",
            "department": "None"
        },
        {
            "first_name": "Raymond",
            "middle_name": "D.",
            "last_name": "Pitteti",
            "name_suffix": "",
            "institution": "Children’s Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Pediatric Emergency Medicine, Pittsburgh, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Melissa",
            "middle_name": "",
            "last_name": "Vitale",
            "name_suffix": "",
            "institution": "Children’s Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Pediatric Emergency Medicine, Pittsburgh, Pennsylvania",
            "department": "None"
        }
    ],
    "date_submitted": "2017-08-10T11:29:21Z",
    "date_accepted": "2017-08-10T11:29:21Z",
    "date_published": "2018-02-26T17:40:38Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/11102/galley/5971/download/"
        }
    ]
}