Challenges in Sedation Prescreening
By Lorie Reilly MSN, CRNP, CPNP-AC, FAARINSedation/Radiology Nurse PractitionerThe Children’s Hospital of Philadelphia In November 2011, a multidisciplinary group of sedation experts convened to define the core aspects of quality in pediatric sedation. They integrated the framework of the Institute of Medicine’s Six Quality Aims: safety, effectiveness, patient and family centered care, timeliness, efficiency and…
Lorie Reilly MSN, CRNP, CPNP-AC, FAARIN
Origin of Caleb’s Law
By John H. Unkel, MD, MPA, DDS, FAAP Six year old Caleb Sears died in an oral surgeon’s office in 2015 following administration of five sedatives resulting in apnea and cardiac arrest. In response to the adverse event the California Assembly requested the Dental Board of California to review current statutes on dental anesthesia/deep sedation….
Is Sedation Consent the Same as Anesthesia Consent?
By Vanessa A. Olbrecht, MD, MBA, FASA Informed consent is one of the most important concepts in medicine. During the process, the care team partners with a child and parents/guardians to provide information to them, enabling them to come to an appropriate decision about proceeding with care. By creating this partnership, the consent process may…
Is our sedation service efficient? How can we tell?
By Cheri D. Landers, MD, FCCM Measuring sedation service efficiency can be challenging. First, there is not a single measure used by all providers for sedation service efficiency. Per the IOM definition, efficient care “avoids waste including waste of equipment, supplies, ideas and energy”. Great Expectations – Defining Quality in Pediatric Sedation (1) is the…
Safety in Sedation – Not Just Physical
By Laura Mitchell, CCLS What does “patient safety” mean to you? In the world of pediatric procedural sedation, we consider safety as relating to the physical safety of our patients. We rely on standards of care set forth by The Joint Commission and the Center for Medicare/Medicaid Services. In our own SPS Center of Excellence…
Dexmedetomidine and Propofol Sparing
By Pradip Kamat An ideal sedative would have properties such as short context-sensitive half-life (quick onset, quick offset), elimination independent of organ function with no active metabolites, minimal depression of respiratory or cardiac systems, and inexpensive. Unfortunately, none of the commonly used sedatives used in pediatric procedural sedation are completely ideal. Sedation practitioners, therefore, commonly…
Musings on Allergic Reactions in the Pediatric Sedation Unit
By Sue Kost, MD While preparing a sedation talk for a group of fellows recently, I took a look at the literature around propofol use in kids with food allergy, in particular egg, soy, and peanut allergies. In an old version of a standard sedation talk, I had included a phrase something like “use propofol…
Does My Patient Really Need MRI Sedation?
For those of us who regularly sedate children for MRI procedures, it’s a frequent challenge to determine who will actually need sedation versus who will be able to complete the MRI without medication. I have seen four-year-old girls happily complete an MRI without sedation while 17-year-old developmentally typical adolescents could not manage to stay still. …