Newsmaker Interview

Literature Review:
Propofol sedation: intensivists’ experience with 7304 cases in a children’s hospital

Point of Interest

Point of Interest

In the January 2008 issue of Pediatric Anesthesia there were several articles devoted to pediatric sedation.  The issue includes a report on the development of national guidelines for sedation in Scotland.  The information on these guidelines was presented as a short article in this issue – entitled SIGN guideline 58: safe sedation of children undergoing diagnostic and therapeutic procedures. Pediatric Anesthesia Volume 18 Issue 1 Page 11-12 January 2008.  The full guideline, references and supporting documentation is available at http://www.sign.ac.uk or at http://www.sign.ac.uk/pdf/sign58.pdf) According to the short article these guidelines were intended to answer the key questions as to:

• What are the requirements for safe pediatric sedation in terms of patient selection, patient preparation, personnel, monitoring, record-keeping, and postprocedure care?
• Which techniques are appropriate to achieve safe sedation of children?
• How do these sedation techniques perform in terms of efficacy, adverse effects and safety?

Apparently the definitions used for sedation levels used in developing the Scottish documents were identical to those used in the AAP guidelines however no agreement was reached with the dentists in Scotland – so they are not included in this guideline. The guideline is extensive and includes chapters on prepartation, techniques, provider requirements etc. We have to applaud the idea of coming up with national standards and guidelines – as well as the supporting materials that are included in these guidelines.  It may well represent a template for the future development of a standard approach to sedation delivery in the USA (building on the work that has gone into the AAP guidelines).  On the other hand, a quick viewing of the materials in this website points out some of the clear differences in practice between Scotland and (at least) the USA.  For instance – the guideline recommends general anesthesia for all GI procedures in children and general anesthesia for painful oncology procedures in children. Once again we find the idea of evidence based national guideline development (that are as extensive as these) to be interesting – and will not quibble with the details of the recommendations themselves.  They are worth viewing.

The same January Pediatric Anesthesia Issue includes several additional articles on sedation that we reserve the right to review in future issues of the newsletter. They include:
Round and round we go: sedation – what is it, who does it, and have we made things safer for children?
CHARLES J. COTÉ, MD
pages 3–8

Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update
pages 9–10

Conscious sedation in pediatric dentistry. A short review of the current UK guidelines and the technique of inhalational sedation with nitrous oxide
I. HOLROYD Bsc BDS FDS (Paed Dent) RCS Eng
pages 13–17

Deep sedation and minimal anesthesia
MICHAEL R.J. SURY FRCA AND JONATHAN H. SMITH FRCA
pages 18–24

Ketamine for procedural sedation and analgesia in pediatric emergency medicine: a UK perspective
NEIL S. MORTON MBChB, FRCA, FRCPCH
pages 25–29

Training and credentialing in procedural sedation and analgesia in children: lessons from the United States model
BARUCH KRAUSS MD EdM AND STEVEN M. GREEN MD
pages 30–35

Investigating the pharmacodynamics of ketamine in children
DAVID W. HERD BSc MB ChB, BRIAN J. ANDERSON PhD FANZCA, NATALIE A. KEENE MSosSc PGDipPsych(Clin) AND NICHOLAS H.G. HOLFORD MB ChB FRACP
pages 36–42

Propofol–ketamine vs propofol–fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changesa
ZEYNEP TOSUN MD, ALIYE ESMAOGLU MD AND ATILLA CORUH MD
pages 43–47

Sedation with ketamine and low-dose midazolam for short-term procedures requiring pharyngeal manipulation in young children
HELENA NOVAK MD, PIA KARLSLAND ÅKESON MD PhD AND JONAS ÅKESON MD PhD DEAA
pages 48–54

Effect of propofol on emergence behavior in children after sevoflurane general anesthesia
IBRAHIM ABU-SHAHWAN MD
pages 55–59

Thanks and please send your comments and questions to Joseph Cravero, MD.

Editors:
Joseph Cravero MD
George Blike MD

Departments of Anesthesiology
and Pediatrics,
Children’s Hospital
at Dartmouth,
Dartmouth Hitchcock
Medical Center,
Lebanon, NH

Circulation
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