Sedation-1 - Pediatric Sedation 2002 The Safety Net Kevin M...

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Unformatted text preview: Pediatric Sedation 2002: The Safety Net Kevin M. Creamer M.D. FAAP Pediatric Critical Care Walter Reed AMC The good old days… Child receives Demerol-Phenergan-Thorazine for laceration repair in ED dies during procedure 1yo former preemie sedated with chloral hydrate at home in preparation for BAER, dies in car en-route to study Agitated encephalopathic 7yo sedated for LP codes in ICU during procedure “Conscious sedation”: Time for this oxymoron to go away! Charles Cote Beware of “ Eminence Based Medicine ” - making the same mistakes with increasing confidence over an impressive number of years Sedation Overview Study Type Number of Complications % Procedures Non-Invasive 6907 96 1.4 Invasive Deep 3038 297 9.8 Combined 3052 63 2.1 Grand total 12997 456 3.5 “Good judgement comes from experience. Experience comes from bad judgement” Definitions Definitions Conscious sedation Conscious sedation vs vs Deep Sedation Deep Sedation vs vs Anesthesia Anesthesia Non-distinct continuum which can change Non-distinct continuum which can change over time over time Wake Up Call : JCAHO 2001 Definitions Minimal Sedation (anxiolysis) –drug induced state which patients can respond normally to verbal commands. Ventilatory and cardiovascular function are unaffected. We almost never do this Some Heme/Onc procedures JCAHO 2001 Definitions Moderate sedation/analgesia (“conscious sedation”) – a drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. JCAHO 2001 Definitions Deep sedation/analgesia- a drug induced depression of consciousness during which patients cannot be easily aroused, but respond purposefully followed repeated or painful stimulation . Patients may require assistance in maintaining a patent airway and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. JCAHO 2001 Definitions Anesthesia - a drug induced loss consciousness during which patients are not arousable, even by painful stimuli. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because depressed ventilation or drug induce impairment of neuromuscular function. Cardiovascular function may be impaired . Ability to Rescue The Licensed independent practitioner must be able to rescue those patients who unavoidably or unintentionally slip into a deeper-than-desired level of sedation Credentialed to do moderate>> rescue from deep Manage a compromised airway and to provide adequate oxygenation and ventilation Credentialed to do deep >> rescue from general anesthesia Above + competent to manage an unstable cardiovascular system Sedation Continuum...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Sedation-1 - Pediatric Sedation 2002 The Safety Net Kevin M...

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