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.