Sedation and analgosedation performed by pediatricians—experience made with the implementation of an in-house sedation standard

Abstract

(Analgo-) sedations for diagnostic and/or therapeutic procedures form part of the daily clinical routine for pediatric patients. National and international medical specialist associations have published guidelines indicating the general conditions of these procedures, yet the recommendations are not always consistent. Since anesthesiological activities are increasingly performed by nonanesthesiologists at our hospital, the Pediatric Clinic of the University Hospital of Saarland considered it necessary to develop an in-house standard. On the basis of a standard dating back to 2005, which was developed and clinically applied by two of the authors of this article, we created our "Homburg standard", taking into account the guidelines of the specialist associations and the international literature. This standard covers patient information, the consumption of food and drink, monitoring before, during and after the sedation as well as documentation. We will present the process of how our standard was established by analyzing protocols of the "old" standard-applied for a period of 18 months-and the application of our standard to two new studies performed at our hospital. In total, 159 sedations of the 18-month reference period could be evaluated; the two studies accounted for 72 sedations for diagnostic and/or interventional cardiac catheter examinations and 40 sedations for outpatient TEE examinations. None of the procedures was associated with complications endangering the safety of a patient. Whereas the documentation of the two studies was nearly complete, it varied considerably in the case of the 159 sedations, depending on how much time had passed since the most recent training. Our standard is a practicable and safe method of performing sedations and analgosedations in pediatric patients. In addition, this standard allows clinical studies to be carried out and evaluated, taking into account certain organizational measures. The development of a specific guideline by the DGKJ and/or the GNPI is considered desirable.