Sedation Protocols—Why So Many Variations?

PEDIATRICS ◽  
1994 ◽  
Vol 94 (3) ◽  
pp. 281-283 ◽  
Author(s):  
Charles J. Coté
Keyword(s):  
Adverse Events ◽  
Word Of Mouth ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Deep Sedation ◽  
Considerable Time ◽  
American Academy Of Pediatrics ◽  
Appropriate Care ◽  
Dental Office ◽  
Difficult Issue

The Committee on Drugs (COD) of the American Academy of Pediatrics (AAP), along with its many consultants, has spent considerable time addressing the difficult issue of appropriate care for sedated pediatric patients. The Committee's concern has been the continued appearance of reports, nearly always from nonmedical journal sources ("word of mouth", newspapers), of children suffering adverse events (morbidity and mortality) after sedation for procedares that in themselves should not result in any such complications, eg, radiologic investigations.1-4 The original "Guidelines for the Elective Use of Conscious Sedation, Deep Sedation, and General Anesthesia in Pediatric Patients" were published in 1985.5 These were constructed because of concern regarding a number of deaths that occurred in the dental office.6

Guidelines for the Elective Use of Conscious Sedation, Deep Sedation, and General Anesthesia in Pediatric Patients

PEDIATRICS ◽  
1985 ◽  
Vol 76 (2) ◽  
pp. 317-321
Author(s):  
◽  
Keyword(s):  
General Anesthesia ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Deep Sedation ◽  
Loss Of Consciousness ◽  
Physical Stimulation ◽  
Verbal Command ◽  
Patent Airway ◽  
Level Of Consciousness ◽  
Definition Of

The goals of sedation and general anesthesia in the ambulatory patient are: (1) patient welfare; (2) control of patient behavior; (3) production of positive psychological response to treatment; and (4) return to pretreatment level of consciousness by time of discharge. DEFINITION OF TERMS Terms used in this document are defined as follows: Pediatric patients: Includes all patients who are infants, children, and adolescents less than age of majority. Must or shall: Indicates an imperative need and/or duty; as essential or indispensable; mandatory. Should: Indicates the recommended manner of obtaining the standard; highly desirable. May or could: Indicates freedom or liberty to follow a suggested or reasonable alternative. Conscious sedation: Conscious sedation is a minimally depressed level of consciousness that retains the patient's ability to maintain a patent airway independently and continuously, and respond appropriately to physical stimulation and/or verbal command, eg, "Open your eyes." For the very young or handicapped individual, incapable of the usually expected verbal responses, a minimally depressed level of consciousness for that individual should be maintained. The caveat that loss of consciousness should be unlikely is a particularly important part of the definition of conscious sedation, and the drugs and techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Deep sedation: Deep sedation is a controlled state of depressed consciousness or unconsciousness from which the patient is not easily aroused, which may be accompanied by a partial or complete loss of protective reflexes, including the ability to maintain a patent airway independently and respond purposefully to physical stimulation or verbal command.

Guidelines for the Elective Use of Conscious Sedation, Deep Sedation, and General Anesthesia in Pediatric Patients

PEDIATRICS ◽  
1986 ◽  
Vol 77 (5) ◽  
pp. 754-754
Author(s):  
Keyword(s):  
General Anesthesia ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Deep Sedation ◽  
Intravenous Access ◽  
Intravenous Line ◽  
Intravenous Infusions

Clarification The AAP Committee on Drugs and Section on Anesthesiology wish to clarify those portions of the Guidelines (Pediatrics 1985;76:317-321, August) that pertain to an intravenous line. Under some circumstances (eg, very short procedures, availability of persons skilled in establishing intravenous lines in children), it may not be necessary that an intravenous line be in place. Therefore, the Guidelines are modified as follows. In section II, "Deep Sedation," the recommendation should read: Patients receiving deep sedation should have an intravenous line in place or have immediately available a person skilled in establishing intravenous infusions in pediatric patients. In section III, "General Anesthesia: Intravenous Access," the recommendation should read: Patients receiving ambulatory general anesthesia shall have an intravenous line in place or have immediately available a person skilled in establishing intravenous infusions in pediatric patients.

Post-Discharge Events Occurring after Dental Treatment under Deep Sedation in Pediatric Patients

2017 ◽  
Vol 41 (3) ◽  
pp. 232-235 ◽  
Author(s):  
Esti Davidovich ◽  
Liron Meltzer ◽  
Jacob Efrat ◽  
David Gozal ◽  
Diana Ram
Keyword(s):  
Adverse Events ◽  
Study Design ◽  
Pediatric Patients ◽  
Dental Treatment ◽  
Deep Sedation ◽  
Parent Report ◽  
Older Children ◽  
Post Discharge ◽  
Convenience Sample ◽  
Sedative Agent

Purpose: Deep sedation is often required in dentistry for treating children with uncooperative behavior. We assessed immediate post-sedation events during the first 24 hours after dental treatment under deep sedation in children, and examined correlations to a number of variables. Study design: Information was collected from medical files for a convenience sample of children between the ages of 1 and 16, who were treated under deep sedation at one clinic (propofol alone or combined with a sedative agent). Parents were interviewed by telephone regarding the first 24 hours following treatment. Results: Among 32 children under age 6 years, 26 (81.3%) had at least one post sedation complication, compared to 19/22 (86.4%) aged 6 and older, p>0.05. According to parent report, 13 (59.1%) of the older children had pain, compared to 6 (18.8%) of the younger ones, p=0.002. For no patient in the younger group compared to 18.2% in the older group was dizziness reported as a complication, p=0.023. Among those who received a sedative agent, 93.3% had one or more complications; 26.7% had nausea or vomiting. The respective rates were 79.5% and 5.1% among those treated only with propofol. Conclusions: Though safe, deep sedation poses complications and adverse events.

Efficacy of an Oxycodone-Propofol Combination versus a Fentanyl-Propofol Combination in Conscious Sedation during Therapeutic Endoscopic Retrograde Cholangiopancreatography in Elderly Patients

Gerontology ◽  
2020 ◽  
pp. 1-8
Author(s):  
Peipei Guo ◽  
Huisheng Wu ◽  
Lan Liu ◽  
Qiu Zhao ◽  
Zhao Jin
Keyword(s):  
Adverse Events ◽  
Elderly Patients ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Postoperative Nausea ◽  
Recovery Time ◽  
Adverse Reactions ◽  
Conscious Sedation ◽  
Endoscopic Retrograde ◽  
Patients Satisfaction ◽  
Low Incidence

<b><i>Background:</i></b> With a rapidly aging population, the need for endoscopic retrograde cholangiopancreatography (ERCP) is increasing. The commonly used sedation anesthesia in ERCP is a combination of propofol and fentanyl, even though fentanyl may cause some adverse reactions such as respiratory depression. <b><i>Objectives:</i></b> This study aimed to evaluate the efficacy of oxycodone combined with propofol versus fentanyl combined with propofol for sedation anesthesia during ERCP. <b><i>Methods:</i></b> A total of 193 patients aged from 65 to 80 years undergoing ERCP were enrolled and randomized into two groups: an “oxycodone combined with propofol” group (group OP, <i>n</i> = 97) and a “fentanyl combined with propofol” group (group FP, <i>n</i> = 96). The rate of perioperative adverse events as well as the recovery time, patients’ satisfaction, and endoscopists’ satisfaction were noted. <b><i>Results:</i></b> There was no difference in the frequency of hypotension or bradycardia between the two groups, but there were more episodes of desaturation (SpO<sub>2</sub> &#x3c;90% for &#x3e;10 s in 8.3%), postoperative nausea (7.3%), and vomiting (5.2%) in group FP than in group OP. Patients’ satisfaction in group FP was lower than that in group OP. The recovery time was longer in group FP than in group OP. <b><i>Conclusions:</i></b> Oxycodone combined with propofol was effective in ERCP, with a low incidence of perioperative adverse events.

Sign in / Sign up

Export Citation Format

Share Document