Is Procedural Intravenous Anesthesia Safe for Children? An Analysis of Nationwide Accident Registries in Japan
Megumi Matsumoto, Eisuke Inage, Shun Toriumi, Akifumi Endo, Yosuke Nakabayashi, Susumu Yokoya, Itaru Iwama, Yasuyuki Suzuki, Shoichi Oyama, Nobuaki Michihata, Takahiro Kudo, Yoshikazu Ohtsuka, Toshiaki Shimizu, Hiromichi ShojiABSTRACT
Background
Although pediatric intravenous anesthesia is widely employed outside operating rooms, it poses risks for serious complications such as airway obstruction and apnea. In Japan, the actual numbers and trends of medical accidents associated with pediatric intravenous anesthesia remain unclear, and the safety of procedural intravenous anesthesia in children has not been sufficiently investigated.
Methods
We extracted accident reports on pediatric intravenous anesthesia for medical procedures from a nationwide, anonymized Japanese accident registry database over 13 years. The reports were analyzed to describe the clinical characteristics of the reported severe adverse events.
Results
A total of 79 accident reports related to intravenous anesthesia were registered, accounting for 0.017% of the total number of intravenous anesthesia procedures. Among these, 70 (88.6%) accident cases occurred in children aged 0–9 years and 9 (11.8%) in patients older than 10 years. Four cases resulted in death and eight in cardiopulmonary arrest, all involving serious underlying medical conditions and occurring during prolonged and highly invasive procedures. When categorized by age, six cases (75.0%) involved children aged 0–9 years and 2 (25.0%) involved patients older than 10 years. The most common underlying disease categories were cardiac disease ( n = 7) and the most frequent procedures were cardiac catheterization ( n = 5). The number of physicians exclusively assigned to anesthesia induction and monitoring using capnometers was not reported.
Conclusions
This nationwide registry analysis characterizes severe pediatric intravenous anesthesia–related adverse events in Japan and highlights the importance of risk stratification and specialist involvement in high‐risk cases.