The use of procedural sedation and general anaesthesia for intra-articular steroid injection procedures: 5 year's experience at Queensland children's hospital

Abstract

Aims: The role of intra-articular steroid (IAS) injections is well-established in the management of patients with Juvenile Idiopathic Arthritis (JIA), but the procedural sedation requirements are less well described. We sought to describe the use of IAS injections in the management of a cohort of patients with JIA at a tertiary paediatric rheumatology centre, with a particular focus on the sedation or anaesthetic requirements for these procedures. We compared this data with published information on procedural sedation practices at other paediatric rheumatology services in Australia. Methods: All patients with JIA attending the Queensland Children's Hospital, Brisbane, between Jan 01 2014 and December 31 2019 were identified utilising the Rheumatology service dashboard. This is a bespoke digital registry which captures codified data from within the electronic medical record. Data was extracted into Microsoft Excel and analysed using descriptive statistics. Results: 328 patients were newly diagnosed with JIA during this period. 61% of newly diagnosed patients were female, and 65% under 12 years of age. During the study period, 185 patients underwent 1094 separate joint injection procedures. 85% of procedures were performed under general anaesthetic (GA); 14% were performed using nitrous oxide sedation and a single procedure was performed without any agent. This compares with a published GA rate of 47% at a comparable Australian centre. The median age of patients receiving GA was 11, while that of sedation was 14.5. Conclusions: IAS injections are widely used for the treatment of JIA at our centre, often repeated within the same patient. GA is employed for the vast majority of these injections, with a rate of GA use almost double that of a comparable Australian service. This study will provide a baseline for further investigation into the reasons for the high use of GA at for IAS injections at the Queensland Children's Hospital.L6354383842021-07-13 <br />