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The use of a pediatric emergency medicine–staffed sedation service during imaging: a retrospective analysis

      Abstract

      Hypothesis

      A sedation service staffed by pediatric emergency medicine (PEM) physicians can sedate children during imaging, with a low adverse event risk and minimal sedation failures.

      Design/Methods

      We reviewed 1042 PEM-administered sedations during a 12-month period, collecting data regarding demographics, presedation evaluation, medications used, sedation length, adverse events, corrective measures, and postsedation disposition. Successful image completion without patient awakening defined effective sedation. Minor adverse events included hypoxia (<93%), malaligned airway, self-resolving transient bradycardia, and atypical reactions to sedation agents. Cardiorespiratory incidents requiring resuscitation were considered major events.

      Results

      Of 923 sedation episodes, 92 (10.0%) experienced adverse events; 7 (0.76%) were major. Sedation failed in 17 (1.8%). No sedation resulted in an increased level of care or permanent injury.

      Conclusions

      A PEM-staffed sedation service provided sedation to children undergoing imaging with a low adverse event risk, minimal failures, and no residual morbidity. However, all sedating clinicians should possess critical airway skills.
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      References

        • Hubbard A.M.
        • Markowitz R.I.
        • Kimmel B.
        • Kroger M.
        • Bartko M.B.
        Sedation for pediatric patients undergoing CT and MRI.
        J Comput Assist Tomogr. 1992; 16: 3-6
        • American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists
        Practice guidelines for sedation and analgesia by non-anesthesiologists.
        Anesthesiology. 2002; 96: 1004-1017
        • Shankar V.
        • Deshpande J.K.
        Procedural sedation in the pediatric patient.
        Anesthesiol Clin North America. 2005; 23: 635-654
        • Hung C.T.
        • Chow Y.F.
        • Fung C.F.
        • Koo C.H.
        • Lui K.C.
        • Lam A.
        Safety and comfort during sedation for diagnostic or therapeutic procedures.
        Hong Kong Med J. 2002; 8: 114-122
      1. Guidelines for the elective use of conscious sedation, deep sedation, and general anesthesia in pediatric patients. Committee on Drugs. Section on anesthesiology.
        Pediatrics. 1985; 76: 317-321
        • American Academy of Pediatrics Committee on Drugs
        Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures.
        Pediatrics. 1992; 89: 1110-1115
      2. Use of pediatric sedation and analgesia. American College of Emergency Physicians.
        Ann Emerg Med. 1997; 29: 834-835
      3. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: addendum.
        Pediatrics. 2002; 110: 836-838
        • Godwin S.A.
        • Caro D.A.
        • Wolf S.J.
        • Jagoda A.S.
        • Charles R.
        • Marett B.E.
        • et al.
        Clinical policy: procedural sedation and analgesia in the emergency department.
        Ann Emerg Med. 2005; 45: 177-196
        • Pitetti R.D.
        • Singh S.
        • Pierce M.C.
        Safe and efficacious use of procedural sedation and analgesia by nonanesthesiologists in a pediatric emergency department.
        Arch Pediatr Adolesc Med. 2003; 157: 1090-1096
        • Barbi E.
        • Gerarduzzi T.
        • Marchetti F.
        • Neri E.
        • Verucci E.
        • Bruno I.
        • et al.
        Deep sedation with propofol by nonanesthesiologists: a prospective pediatric experience.
        Arch Pediatr Adolesc Med. 2003; 157: 1097-1103
        • Cote C.J.
        • Notterman D.A.
        • Karl H.W.
        • Weinberg J.A.
        • McCloskey C.
        Adverse sedation events in pediatrics: a critical incident analysis of contributing factors.
        Pediatrics. 2000; 105: 805-814
        • Newman D.H.
        • Azer M.M.
        • Pitetti R.D.
        • Singh S.
        When is a patient safe for discharge after procedural sedation? The timing of adverse effect events in 1367 pediatric procedural sedations.
        Ann Emerg Med. 2003; 42: 627-635
        • Pena B.M.
        • Krauss B.
        Adverse events of procedural sedation and analgesia in a pediatric emergency department.
        Ann Emerg Med. 1999; 34: 483-491
        • Agrawal D.
        • Manzi S.F.
        • Gupta R.
        • Krauss B.
        Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department.
        Ann Emerg Med. 2003; 42: 636-646
        • Hoffman G.M.
        • Nowakowski R.
        • Troshynski T.J.
        • Berens R.J.
        • Weisman S.J.
        Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model.
        Pediatrics. 2002; 109: 236-243
        • Lowrie L.
        • Weiss A.H.
        • Lacombe C.
        The pediatric sedation unit: a mechanism for pediatric sedation.
        Pediatrics. 1998; 102: E30
        • Gozal D.
        • Drenger B.
        • Levin P.D.
        • Kadari A.
        • Gozal Y.
        A pediatric sedation/anesthesia program with dedicated care by anesthesiologists and nurses for procedures outside the operating room.
        J Pediatr. 2004; 145: 47-52
        • King W.K.
        • Stockwell J.A.
        • Deguzman M.A.
        • Simon H.K.
        • Khan N.S.
        Evaluation of a pediatric sedation service for common diagnostic procedures.
        Acad Emerg Med. 2006; : 673-676
        • Pershad J.
        • Gilmore B.
        Successful implementation of a radiology sedation service staffed exclusively by pediatric emergency physicians.
        Pediatrics. 2006; 117: e413-e422
        • Godambe S.A.
        • Elliot V.
        • Matheny D.
        • Pershad J.
        Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department.
        Pediatrics. 2003; 112: 116-123
      4. Accreditation Council for Graduate Medical Education. Program requirements for residency education in pediatric emergency medicine, June 1998. Available at: http://acgme.org/acWebsite/downloads/RRC_progReq/324pr698.pdf. Accessed August 2, 2004.

        • Mace S.E.
        • Barata I.A.
        • Cravero J.P.
        • Dalsey W.C.
        • Godwin S.A.
        • Kennedy R.M.
        • et al.
        Clinical policy: evidence-based approach to pharmacologic agents used in pediatric sedation and analgesia in the emergency department.
        Ann Emerg Med. 2004; 44: 342-377
        • Krauss B.
        • Green S.M.
        Sedation and analgesia for procedures in children.
        N Engl J Med. 2000; 342: 938-945
        • Bassett K.E.
        • Anderson J.L.
        • Pribble C.G.
        • Guenther E.
        Propofol for procedural sedation in children in the emergency department.
        Ann Emerg Med. 2003; 42: 773-782
        • Guenther E.
        • Pribble C.G.
        • Junkins Jr, E.P.
        • Kadish H.A.
        • Bassett K.E.
        • Nelson D.S.
        Propofol sedation by emergency physicians for elective pediatric outpatient procedures.
        Ann Emerg Med. 2003; 42: 783-791
        • Cravero J.P.
        • Blike G.T.
        Review of pediatric sedation.
        Anesth Analg. 2004; 99: 1355-1364
        • Moro-Sutherland D.M.
        • Algren J.T.
        • Louis P.T.
        • Kozinetz C.A.
        • Shook J.E.
        Comparison of intravenous midazolam with pentobarbital for sedation for head computed tomography imaging.
        Acad Emerg Med. 2000; 7: 1370-1375
        • Kennedy R.M.
        • Porter F.L.
        • Miller J.P.
        • Jaffe D.M.
        Comparison of fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic emergencies.
        Pediatrics. 1998; 102: 956-963