(1016) Trends in Sedation and Analgesia in Postoperative Pediatric Liver Transplant Patients

Tuesday, January 23, 2024

12:30 PM – 1:30 PM MT

Location: Connections Central - RST 15

First Author(s)

Matthew A. Goldstein

Children's Healthcare of Atlanta - Egleston Hospital
Atlanta

Co-Author(s)

AJ

Andrew Jergel, N/A

Biostatistician
Emory University School of Medicine, United States
SK

Saul Karpen, MD, PhD

Professor of Pediatrics - Division Chief, Pediatric Gastroenterology, Hepatology and Nutrition
Children's Healthcare of Atlanta - Emory University School of Medicine, United States
LG

Laura Gilbertson, MD

Assistant Professor - Pediatric Anesthesiology
Children's Healthcare of Atlanta - Emory University School of Medicine, United States
Akash Deep, MD, FRCPCH (he/him/his)

Consultant Pediatric Intensivist
King's College Hospital
London
ZH

Zhulin He, PhD

Pediatric Biostatistician
Emory University and Children's Healthcare of Atlanta, United States
TA

Thomas Austin, MD, MS

Professor of Anesthesiology and Associate Chief, Division of Pediatric Anesthesiology
University of Florida, United States
MH

Matthew Hall, PhD

Co-Director of Health Services Research Academy, Principal Biostatistician
Children's Hospital Association, United States
Pradip Kamat, MBA, MD, FAAP, FCCM

Professor of Pediatrics, Division of Pediatric Critical Care Medicine
Children's Healthcare of Atlanta
Atlanta, Georgia, United States

Introduction: Children admitted to the pediatric intensive care unit (PICU) following liver transplantation frequently require analgesia and sedation in the immediate postoperative period. Our objective was to assess trends and variations in sedation and analgesia used in this cohort utilizing the Pediatric Health Information System (PHIS) database. We hypothesize that in postoperative liver transplant patients, there is a decreasing trend in the use of benzodiazepines, an increase in the use of dexmedetomidine, and no change in use of the opioids.

Methods: Multicenter retrospective cohort study using PHIS data from 2012-2022. Study years were grouped into epochs: 2010–2012, 2013–2015, 2016–2018, and 2019–2022. Categorical variables were summarized with frequencies and percentages and compared across epochs using chi-squared tests. Trends in annual rates of liver transplantation PICU admissions and medications used were assessed with Cochran-Armitage trend tests.

Results: We evaluated 3,963 pediatric patients from 32 US children’s hospitals who received a liver transplantation and were admitted to the PICU post operatively, with mean age of 5.16 years [5.74]. 54% of patients received mechanical ventilation (MV) post operatively. There were statistically significant differences between patients receiving MV vs. non-MV in terms of IV medication use -- morphine (57% vs 49%, p< 0.001), fentanyl (57% vs 44%, p< 0.001), midazolam (45% vs 31%, p< 0.001), lorazepam (39% vs. 24%, p< 0.001), propofol (30% vs 26%, p< 0.001), dexmedetomidine (38% vs 30%, p< 0.001), and ketamine (25% vs 12%, p< 0.001). There was a significant difference in vasopressor use (35% vs. 22%, p< 0.001). There was an increasing trend in use of intravenous acetaminophen, dexmedetomidine and ketamine, while use of benzodiazepines decreased (p < 0.001).

Conclusions: About 50% of liver transplant patients still receive MV in the PICU postoperatively and subsequently receive more benzodiazepines compared to non-MV. However, there is an increasing trend in dexmedetomidine, intravenous acetaminophen and ketamine usage during the study period with an overall decreasing trend in use of benzodiazepines. An opportunity exists for pediatric intensivists to standardize sedation and analgesia in postoperative liver transplant patients admitted to the PICU.