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Editorial | Comparative Effectiveness Research

American Academy of Pediatrics Sedation Guidelines:  Are We There Yet?

Charles J. Coté, MD
Arch Pediatr Adolesc Med. 2012;166(11):1067-1069. doi:10.1001/archpediatrics.2012.1355.
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In this issue of the Archives, an “Original Article” from the Pediatric Sedation Research Consortium (PSRC) clarifies physiologic monitoring practices during pediatric sedation.1 The PSRC is a dedicated group of individuals from a variety of subspecialties, including anesthesiology,2 and they are to be congratulated for the veracity of their information and the fact that they are willing to publish their findings. This prospective data collection has carefully categorized the types of physiologic monitoring and monitoring combinations according to differing patient populations, subspecialists, medications used to provide sedation, and the procedures the children underwent. These data are particularly important as increasing numbers of children are sedated with potent anesthetic medications.3 Data from 114 322 children cared for in 37 institutions were collected and analyzed. A surprising result was that the guidelines from the American Academy of Pediatrics (AAP)4 were only fully followed in 52% of children. If this dedicated group of individuals did not follow the AAP guidelines in almost 50% of cases, what is really happening in institutions and with individuals who do not have the positive motivations of the PSRC membership? It is of particular concern that radiologists did not use any monitors on approximately 40% of children and only 33% used pulse oximetry, yet this subgroup of practitioners are likely to have the least facility with emergency airway management due to their area of specialization and training. This lack of adherence to sedation guidelines is akin to driving a car at night with no headlights and no speedometer; at some point a disaster will happen.

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