Procedural anesthesia and sedation for children undergoing diagnostic and medical procedures - a review of post-procedural pain, nausea and vomiting by questionnaire-based survey.

Background Sedation and anesthesia are widely used to relieve pain and ensure cooperation during elective diagnostic and medical procedures in the pediatric population. However, there is currently limited evidence about the recovery trajectory following deep sedation or general anesthesia for such procedures in children. Aims The primary aim was to describe the severity and duration of pain, nausea and vomiting after common diagnostic and medical procedures. Secondary outcomes include return to baseline functioning and incidence of medical re-presentation. Methods Recruitment was achieved post-procedurally by telephone interview with parents or legal guardians of patients who underwent botox injection, bronchoscopy, either or both a colonoscopy or UGI endoscopy, or MRI scan. Daily pain scores, nausea and vomiting, administration of at-home analgesia and any adverse events requiring medical attention were obtained. Children were followed until pain completely resolved and baseline activity resumed. Results A total of 307 patients were included (50 botox injection, bronchoscopy and MRI; 48 colonoscopy, 58 UGI endoscopy, 51 colonoscopy plus UGI endoscopy). Parental-rated pain scores peaked on day of procedure across all groups and decreased over time, with most children resuming normal activity within 1 day post-procedure. Pain was mostly mild and resolved quickly in botox injection (10% moderate to severe and 22% mild), bronchoscopy (8% and 10% respectively) and MRI (2% mild) patients. Combined UGI endoscopy and colonoscopy was associated with greatest pain severity (29% moderate to severe and 20% mild). Highest rates of nausea and/or vomiting were observed in colonoscopy (23%), UGI endoscopy (28%) and combined procedure groups (20%). At-home simple analgesia was administered in 21% of patients. Unplanned medical re-presentations were infrequent across all groups. Conclusion This study demonstrates that the recovery trajectory following procedural sedation and anesthesia is short, with minimal requirement for additional medical attention. These findings will aid in alleviating parental anxiety and encourage utilisation of regular simple analgesia.