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The ‘dark’ side of sedation: 12 years of office-based pediatric deep sedation for electroretinography in the dark

Authors

  • Kirk Lalwani,

    1.  Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Doernbecher Children’s Hospital, Portland, OR, USA
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  • Brian D. Tompkins,

    1.  The School of Medicine, Oregon Health & Science University, Doernbecher Children’s Hospital, Portland, OR, USA
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  • Kevin Burnes,

    1.  Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Doernbecher Children’s Hospital, Portland, OR, USA
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  • Melissa R. Krahmer,

    1.  Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Doernbecher Children’s Hospital, Portland, OR, USA
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  • Mark E. Pennesi,

    1.  Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Doernbecher Children’s Hospital, Portland, OR, USA
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  • Richard G. Weleber

    1.  Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Doernbecher Children’s Hospital, Portland, OR, USA
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  • Section Editor: Charles Cote

Kirk Lalwani, Associate Professor of Anesthesiology and Pediatrics, Anesthesiology and Perioperative Medicine, BTE-2, Oregon Health and Science University, Portland, OR 97239, USA Email: lalwanik@ohsu.edu

Summary

Objectives:  Analyze pediatric ERG data for adverse events, interventions, and outcomes of propofol sedations performed in near-complete darkness.

Aim:  To demonstrate that deep sedation with propofol for ERG can be performed efficiently and safely in children in near-total darkness.

Background:  Full-field electroretinography (ERG) is a valuable tool for the diagnosis of vision loss in children. The ERG measures the electrical activity of the retina. In children, ERG quality significantly improves with deep sedation by allowing easier eye electrode placement and decreasing motion artifacts. As this procedure must be performed in darkness, administering sedation imposes unique challenges.

Methods and materials:  ERGs are performed outside of the operating room in our hospital’s electrophysiology suite. IVs are placed, and patients are allowed to adapt to complete darkness. An anesthesiologist then administers propofol sedation in the dark with the aid of a red-filter light source and monitor light shields. Data were collected on 379 patients (411 ERGs) performed from 1996 to 2008. These records were reviewed and analyzed for demographic, medical, and anesthetic data.

Results:  Propofol sedation resulted in an ERG completion rate of 99.5%. During sedation, 8.5% (35) of patients experienced minor respiratory complications such as airway obstruction that resulted in an oxygen saturation <90%. A total of 9.7% (40) of patients required minor airway interventions such as a chin lift.

Conclusions:  We demonstrated that pediatric sedation is a safe, efficient, and a cost-effective method for measuring ERGs in a challenging environment. The incidence of minor complications is low and appears similar to other studies of propofol sedation.

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