Incidence and risk factors of complications after non-operating room anesthesia in children: a prospective observational study

Background Non-operating room anesthesia (NORA) is increasingly utilized in pediatric practice, but complications remain a concern, particularly in resource-limited settings. Objective To determine the incidence of complications during pediatric NORA and identify associated risk factors. Methods This prospective observational study included 300 children undergoing sedation or anesthesia for diagnostic and therapeutic procedures in radiology and endoscopy departments of a university hospital. Demographics, medical history, procedural details, and complications were recorded. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors. Results The overall complication rate was 8.7% (26/300). Respiratory complications were most frequent (57.7%), followed by emergence agitation (30.8%). Independent risk factors included respiratory distress (adjusted OR = 6.845; 95% CI: 1.986–23.583; p = 0.002), altered consciousness (aOR = 9.127; 95% CI: 1.124–74.123; p = 0.038), and recent upper respiratory infection (aOR = 4.921; 95% CI: 1.042–23.230; p = 0.044). Preanesthetic consultation was protective (aOR = 0.389; 95% CI: 0.154–0.982; p = 0.046). No mortality occurred. Conclusions Complications during pediatric NORA remain significant. Careful patient selection, thorough preanesthetic evaluation, and awareness of risk factors can improve safety. Systematic preanesthetic consultation should be implemented for all pediatric NORA procedures.