Obesity increases the risk of complications during pediatric procedural sedation. The risk of being underweight has not been evaluated in this arena.
Researchers therefore investigated the association of body mass index ( BMI ) with sedation dosing and adverse events in children across a range of BMIs.
A total of 1976 patients ages 2 to 21 years old with oncologic diagnoses underwent lumbar punctures and/or bone marrow aspirations.
All children received a standard adjunctive dose of Ketamine before sedation with Propofol.
Weight categories were stratified by BMI percentile: underweight less than 5%, normal weight 5% to 85%, overweight more than 85%, and obese more than 95%.
There were no differences in Propofol dosing for procedural sedation between patients who were normal weight and underweight.
However, children who were overweight and those who were obese used less Propofol compared with children who were normal weight ( P less than 0.01 ).
Children who were underweight had a higher proportion of adverse events overall relative to those children of normal weight ( P less than 0.001 ).
In contrast, there was not an increase in adverse events for patients who were overweight and obese.
In conclusion, children who are overweight and children with obesity who require deep sedation can undergo successful sedation with lower Propofol dosing relative to children of a normal weight.
This dosing strategy may help to mitigate the risks associated with sedating patients who are obese.
Notably, children who were underweight had an increased rate of complications despite receiving an equal amount of sedation compared with patients who were normal weight. This should alert the clinicians to the risks associated with sedating children who are underweight. ( Xagena2017 )
Rogerson CM et al, Hosp Pediatr 2017;7:542-546