Physiologic Monitoring Practices During Pediatric Procedural Sedation A Report From the Pediatric Sedation Research Consortium Monitoring Practices During Procedural Sedation

Langhan ML, Mallory M, Hertzog J, et al. — Thu, 01 Nov 2012 00:00:00 GMT

Objectives

To describe the frequency of different physiologic monitoring modalities and combinations of modalities used during pediatric procedural sedation; to describe how physiologic monitoring varies among different classes of patients, health care providers (ie, ranging from anesthesiologists to emergency medicine physicians to nurse practitioners), procedures, and sedative medications employed; and to determine the proportion of sedations meeting published guidelines for physiologic monitoring.

Design

This was a prospective, observational study from September 1, 2007, through March 31, 2011.

Setting

Data were collected in areas outside of the operating room, such as intensive care units, radiology, emergency departments, and clinics.

Participants

Thirty-seven institutions comprise the Pediatric Sedation Research Consortium that prospectively collects data on procedural sedation/anesthesia performed outside of the operating room in all children up to age 21 years.

Main Outcome Measures

Data including demographics, procedure performed, provider level, adverse events, medications, and physiologic monitors used are entered into a web-based system.

Results

Data from 114 855 subjects were collected and analyzed. The frequency of use of each physiologic monitoring modality by health care provider type, medication used, and procedure performed varied significantly. The largest difference in frequency of monitoring use was seen between providers using electrocardiography (13%-95%); the smallest overall differences were seen in monitoring use based on the American Society of Anesthesiologists classifications (1%-10%). Guidelines published by the American Academy of Pediatrics, the American College of Emergency Physicians, and the American Society of Anesthesiologists for nonanesthesiologists were adhered to for 52% of subjects.

Conclusions

A large degree of variability exists in the use of physiologic monitoring modalities for pediatric procedural sedation. Differences in monitoring are evident between sedation providers, medications, procedures, and patient types.

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

Coté CJ. — Thu, 01 Nov 2012 00:00:00 GMT

In this issue of the Archives, an “Original Article” from the Pediatric Sedation Research Consortium (PSRC) clarifies physiologic monitoring practices during pediatric sedation. The PSRC is a dedicated group of individuals from a variety of subspecialties, including anesthesiology, 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. 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) 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.

JAMA Pediatrics: Surgical Physiology Topic Collection

Physiologic Monitoring Practices During Pediatric Procedural Sedation A Report From the Pediatric Sedation Research Consortium Monitoring Practices During Procedural Sedation

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