Prevalence and Risk Factors of Adverse Events in Procedural Sedation Outside the Operating Room for Pediatric Dental Procedures.

OBJECTIVES

To determine the prevalence and risk factors of adverse events (AE) in pediatric patients undergoing procedural sedation outside of the operating room (PSOOR) for dental procedures.

DESIGN

A retrospective analysis of prospectively collected data using the Pediatric Sedation Research Consortium database, which collects multicenter, quality-controlled data on pediatric sedations.

SETTING

Twenty-five participating hospitals across the United States, with data collected from July 1, 2020, to June 30, 2024.

PATIENTS: Three thousand five hundred forty-eight pediatric patients undergoing PSOOR for dental procedures.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

The primary outcome was the occurrence of one or more AEs, which were classified as either severe (including both critical and high-risk events) or low-risk based on severity. Thirty-one percent of dental sedations had an AE occur and 5% had a severe AE occur. The most prevalent severe events in dental sedations included complete airway obstruction (2.8%), hypoxia requiring major intervention (1.6%), and laryngospasm (0.8%). Multiple modeling approaches revealed that medication regimen, provider type, neurologic comorbidity, snoring, and obesity were associated with severe AEs after adjusting for confounding variables.

CONCLUSIONS

While PSOOR is generally safe, children undergoing sedation for dental procedures experience high rates of AEs, most commonly airway-related complications. Patient-, provider-, and institution-level factors may increase the risk of AEs. These findings underscore the need for enhanced preprocedural risk assessment and provider training to ensure safety in pediatric dental sedation practices.