Non-Anesthesiologists Can Safely Sedate Children

A new study has found no differences in major complication rates among the many specialties that perform pediatric procedural sedation.

Researchers at the Alfred I. DuPont Hospital for Children (Wilmington, DE, USA) and colleagues in the Pediatric Sedation Research Consortium investigated whether complications are more or less associated with any particular group of specialists. The researchers used data from 38 sites on patients who ranged in age from newborn to 18 years. They then defined major complications as aspiration, death, cardiac arrest, unplanned hospital admission or level-of-care increase, or emergency anesthesiology consultation.

The results showed that out of 131,751 cases of sedation given outside of the operating room, there were no deaths, and other major complications were rare. Sedation was most often administered by intensivists (58,222), emergency physicians (38,293), anesthesiologists (18,343), and pediatricians (12,113). Children were also sedated by pediatric residents or fellows, radiologists, surgeons, dentists, advanced practice nurses, certified registered nurse anesthetists, or registered nurses. There was no statistical difference between providers' major complication rates (either before or after adjustment) for possible confounding variables. Moreover, there was no significant difference between the types of major complication among providers. The study was published online on April 25, 2011, in Pediatrics.

"The rapid growth in the use of sedation services by non-anesthesiologists has been the subject of some concern. Our data reveal that, within our consortium, there was no increased danger associated with pediatric procedural sedation provided by non-anesthesiologists,” concluded lead author James Hertzog, MD. "The application of our data to sites outside of our consortium will require rigorous evaluation of the skill level of the providers and the institution's systemic safeguards for the care of a sedated pediatric patient.”

Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical or diagnostic procedure. It is typically used in procedures such as endoscopy, vasectomy, rapid sequence intubation (RSI), or minor surgery. It is also used in reconstructive dental surgery, pediatric dentistry, or for high-anxiety patients. Sedation methods include inhalation using nitrous oxide (NO2), oral sedation, and intravenous (IV) sedation. Sedation is also used extensively in the intensive care unit (ICU) so that patients who are being ventilated tolerate having an endotracheal tube in their trachea. Drugs that can be used for sedation include propofol, etomidate, ketamine, fentanyl, and midazolam.

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Alfred I. DuPont Hospital for Children