Sedation for an echo for a 6wk old

[mstudent12345]

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MS4 here. I have a scenario which I hope the pros can give their opinion on.

6wk of infant comes to peds cardiology for evaluation of a murmur picked up on exam. Instructions to the parents are NPO for 4 hours prior to exam in case the cardiologist needs to do an echo, in which case there will be sedation.

Upon further questioning it is discovered that the sedation is in the form of PO chloral hydrate and performed by a "Sedation Nurse", not a CRNA or anesthesiologist. Anesthesia is not even on the floor, but is in the medical complex. When asked they say that the cardiologists are all PALS certified they do this thousands of times a year, and a crash cart is down the hall.

My questions are as follows:

1) Is it necessary to sedate a 6wk old for a TTE, why not just hold them down?

2) If you do need sedation is chloral hydrate, given by a "sedation nurse" without any formal anesthesia training, a safe choice or does it carry the same risks as other agents - aspiration, respiratory depression, etc?


Thanks

 

[core0]

MS4 here. I have a scenario which I hope the pros can give their opinion on.

6wk of infant comes to peds cardiology for evaluation of a murmur picked up on exam. Instructions to the parents are NPO for 4 hours prior to exam in case the cardiologist needs to do an echo, in which case there will be sedation.

Upon further questioning it is discovered that the sedation is in the form of PO chloral hydrate and performed by a "Sedation Nurse", not a CRNA or anesthesiologist. Anesthesia is not even on the floor, but is in the medical complex. When asked they say that the cardiologists are all PALS certified they do this thousands of times a year, and a crash cart is down the hall.

My questions are as follows:

1) Is it necessary to sedate a 6wk old for a TTE, why not just hold them down?

2) If you do need sedation is chloral hydrate, given by a "sedation nurse" without any formal anesthesia training, a safe choice or does it carry the same risks as other agents - aspiration, respiratory depression, etc?


Thanks

Not an anesthesia pro but been there done that. For at TTE its helpful to have the patient still. Most six week olds will react appropriately when you put a bunch of slimy gel on their chest and then press a plastic thing into their sternum. Sedating them allows this to be done. Here is a paper on conscious sedation for peds:
http://www.mosbysdrugconsult.com/WOW/op042.html

If you look up the topic of conscious sedation there has been some stuff posted here. Its done probably 100's of thousands of times a day by non-anesthesiologists. The controversy mostly revolves around non-anesthesiologists using Propofol but I'll let the experts tell you more on that. Chloral hydrate is pretty common in peds sedation and found to be safe and effective in a number of studies. For those less old school oral or nasal Versed is very effective also. I don't recall using it in six week olds though.

David Carpenter, PA-C

 

[Monty Python]

.... The controversy mostly revolves around non-anesthesiologists using Propofol but I'll let the experts tell you more on that.....
David Carpenter, PA-C

Propofol's package insert http://66.70.89.95/information/propofol.pdf says it should be only given by persons trained in general anesthesia.

I'm not a lawyer. But I do know that RNs in my state can be prosecuted if they give propofol (except to an intubated ICU patient) as "anesthetics" are limited to CRNAs. Propofol is an anesthetic. They're still doing it in some GI labs --- sooner or later they might get an unwanted letter from the BON.

 

[coprolalia]

Some of the "folks" (no specific group) have begun to do, what is in my opinion, the dangerous practice of given Precedex boluses in such a procedure. This is based on one (or maybe two) stupid paper(s) produced by Boston Children's group.

Well, if it was done a Hah-vud it must be good medicine, right? 🙄

-cop

 

[Planktonmd]

It's very difficult to kill a baby using PO Chloral hydrate.