pediatric sedation

[Perrotfish]

So I have heard that my new hospital currently relies pretty much exclusively on anesthesia for the sedation of pediatric patients. Obviously this makes sense for patents being put under for an operation, but ie anesthesia really necessary to sedate patients for minor procedures like laceration repairs, nursemaids elbows, and MRIs? Because consulting gas slows this entire process down tremendously and if there's a way to speed this up and learn new procedures I would love to do that. Could giving just Ketamine, or propofol, or whatever be accomplished without getting gas involved? What kinds of sedation, if any, are you guys comfortable giving without the supervision of anesthesia?

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[rock_climber]

We give pentobarbital (or the little choral we have left!) for MRI and versed/fentanyl frequently for PICC lines and similar procedures. Ketamine occasionally as well. Our anesthesiologists keep the Propofol and precedex to themselves although dex gets used in the ICU a fair amount by intensivists.

 

[Perrotfish]

We give pentobarbital (or the little choral we have left!) for MRI and versed/fentanyl frequently for PICC lines and similar procedures. Ketamine occasionally as well. Our anesthesiologists keep the Propofol and precedex to themselves although dex gets used in the ICU a fair amount by intensivists.

So the pediatric residents give the anesthesia for the MRI? I just want to be clear who you mean when you say 'we'.

 

[g12321]

We give pentobarbital (or the little choral we have left!) for MRI and versed/fentanyl frequently for PICC lines and similar procedures. Ketamine occasionally as well. Our anesthesiologists keep the Propofol and precedex to themselves although dex gets used in the ICU a fair amount by intensivists.

same here, I've worked only in the neonatal unit for the time being but that's what we do for neonates! How much do you administer?

 

[jonb12997]

our pediatric sedation team (mainly the not currently on service hospitalists, but also the PICU docs) uses propofol. It's unfortunate that most places don't use it because that's what I've been trained to use. We'll also use Versed/Fentanyl in some instances also....

 

[SurfingDoctor]

I suppose it depends on the hospital and protocols/policies in place, but generally speaking ICU and ER docs are or should be fairly comfortable with MAC (monitored anesthesia care) using and understanding the risks of propofol, ketamine, fentanyl, versed (ie anything deep sedation or lighter, not general anesthesia). Some places will have sedation teams for MAC procudures in acute care areas (eg the regular pediatric floor for dressing changes or PCAs) but this is not typically expected in the ICUs or ERs. Residents, should not be doing moderate or deep sedation, in any situation unless some experienced faculty is right there guiding them (as that is a huge liability)

 

[Socrates25]

Sedation for nursemaid elbow reduction? Please tell me you are joking!

I can understand using sedation for lacs or MRI because those can take 15 mins to 1 hour easily, especially if its a brand new intern doing the lac repair. And MRIs require absolutely no motion or the images are ridiculously bad. But a nursemaid literally takes 10 seconds to reduce.

 

[rock_climber]

Yes, we as in the pediatric residents. Interns are not allowed to do so, but upper level residents can give pentobarbital and choral, etc for MRI, etc without staff present. We do a pre-sedation brief chart review and limited physical exam within 30 minutes of giving the sedation. Pentobarbital of 4-6mg/kg. interns can give "anxiolytic" doses of lorazepam, too but I'd had to look up on the hospital policy what the anxiolytic cut-off is.

 

[WestcoastMedicine]

After completing a 3 hour course our residents are all able to give moderate sedation with Fentanyl/Midazolam. Mainly for LPs, anesthesia handles sedation for MRI.

 

[SurfingDoctor]

Moderate sedation without faculty supervision? Well every program is different. Most times things we be fine, but when something goes wrong you better have good airway skills (which is not taught well in residency)