Develop a risk score to establish safe sedation for children by conducting a comprehensive questionnaire survey of sedation complications

• Project/Area Number: 18K17335
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 58010:Medical management and medical sociology-related
• Research Institution: Tokyo Medical University
• Principal Investigator: TAKAHASHI HIDEKUNI 東京医科大学, 医学部, 助教 (10630791)
• Project Period (FY): 2018-04-01 – 2024-03-31
• Project Status: Completed (Fiscal Year 2023)
• Budget Amount: ¥3,640,000 (Direct Cost: ¥2,800,000、Indirect Cost: ¥840,000); Fiscal Year 2020: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000); Fiscal Year 2019: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000); Fiscal Year 2018: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
• Keywords: 鎮静 / MRI / アンケート / リスクスコア

Outline of Final Research Achievements

The questionnaire collection rate was 67.6% (150/222 patients). No serious early complications (cardiac arrest, respiratory arrest, shock) were observed. The most common complication was respiratory failure. Patients with underlying diseases (especially neurological) had a low success rate for MRI imaging due to poor sedation efficacy. Patients with poor sedation tended to receive higher doses of drugs and had more early complications. Late complications included sleep disturbances, agitation, and changes in dietary status, regardless of underlying disease. No cases had ongoing complications or new symptoms more than one day after sedation. The inferred risk of early complications of sedation was the underlying disease and drug dose, while late complications were outlined differently from the risk of early complications.

Academic Significance and Societal Importance of the Research Achievements

薬剤の多剤使用、過量投与、もしくは基礎疾患のある患児でリスクが高くなることは認知されているが、早期合併症と晩期合併症の発症予測は未だ確立したものはない。今回早期合併症については先行研究の通り基礎疾患や薬剤量に比例している傾向であるが、晩期合併症については重篤なものは認めなかったものの、基礎疾患に問わず起きている状況であった。ここから導き出すリスクスコアにより、再度症例に当てはめていく工程が必要ではあるが、その結果によって導かれるスコアは、より確実でより合理的な鎮静を伴う検査への安全対策を実施する上でリスクのある児を効率よく見出す事ができる。医療資源・医療費の観点からも社会的意義がある。