Sedation Program Research Articles

Effective Sedation Strategies for Pediatric MRI: A Comprehensive Analysis

This study presents a structured sedation program for pediatric patients undergoing MRI, aiming to optimize safety and resource utilization. A total of 1857 children were included, with 48 admitted to the RCU, leaving 1809 for analysis. Children under 5 received oral sedation, while those 6 and older were assessed by referring physicians for sedation eligibility. The protocol involved chloral hydrate and paraldehyde, with a backup plan for intravenous sedation or general anesthesia overseen by an anesthetist consultant. Among 1039 scans, 597 were unsedated, and 442 were sedated successfully. Oral sedation failed in 50 cases (6.9%), predominantly in younger children (87% under 5 years). Notably, 2 out of 5 subjects using chloral hydrate experienced respiratory issues. This systematic approach led to efficient resource use and safe outcomes, highlighting the importance of tailored sedation protocols in pediatric imaging. Highlights: Reduced oral sedation failure rate to 6.9% in pediatric MRI. Anesthetist consultation enhances safety in MRI sedation procedures. Structured program optimizes resources and ensures safe outcomes in pediatrics. Keywords: Pediatric MRI, Sedation Program, Anesthetist Consultation, Oral Sedation, Resource Utilization

Palliative sedation determinants: systematic review and meta-analysis in palliative medicine

BackgroundThe utilisation of palliative sedation is often favoured by patients approaching end of life due to the presence of multiple difficult-to-manage symptoms during the terminal stage. This study aimed to...

Establishment of an intravenous conscious sedation service at a University Dental Clinic in Tanzania.

With advances in safety measures for anesthesia, conscious sedation has gained popularity in the field of dentistry and has become essential in dental practice worldwide. However, in Tanzania, intravenous (IV) sedation is rarely practiced in the dental field. Therefore, we report the establishment of sustainable IV conscious sedation in dental practices and subsequently train local OMS residents in Tanzania. In 2019, intravenous conscious sedation was initiated at the University Dental Clinic of the Muhimbili University of Health and Allied Science (MUHAS), Tanzania. During the preparatory phase of the program, local oral and maxillofacial surgeons (OMSs) were given a series of lecture notes that concentrated on different aspects of IV conscious sedation in dentistry. During the on-site training phase, an oral surgeon from the United States joined the OMSs for case selection, IV-conscious sedation procedures, and patient follow-up. Patients were recruited from existing patient records at the MUHAS Dental Clinic. The first conscious IV sedation program in dentistry was successfully launched at the University Dental Clinic in Tanzania. The local team of OMSs was trained on the safe administration of sedative agents (midazolam or ketamine) to perform various minor surgical procedures in a dental office. Nine patients with different ages, body masses, and medical conditions benefited from the training. No complications were associated with IV conscious sedation in the dental office. This was the first successful "hands-on" training on IV conscious sedation provided to OMSs in Tanzania. It laid the foundation for the sustainable care of patients with special needs requiring oral health-related care in the country.

The effects of midazolam or propofol plus fentanyl on ICU mortality: a retrospective study based on the MIMIC-IV database.

BackgroundPatients in the intensive care unit (ICU) are often under stress and fail to cooperate well with invasive treatments. Analgesia and sedation are of great significance for reducing the suffering of patients and ensuring the application and effectiveness of treatment. For better clinical choice, we aimed to explore the effect of the combination of propofol + fentanyl or midazolam + fentanyl on the short-term prognosis of hospitalized patients in the ICU.MethodsAccording to the inclusion and exclusion criteria, we retrospectively included patients in the MIMIC-IV database receiving midazolam + fentanyl or propofol + fentanyl analgesic and sedative treatment using Structured Query Language (SQL) to extract clinical data from the MIMIC-IV database. The primary endpoint was the death rate within 28 days after the patient was admitted to the ICU. Doubly robust estimation was used to infer the relationship between sedation and analgesia and 28 days outcome. The gradient boosted model (GBM) was used to estimate the propensity score (PS) of the patient’s sedation and analgesia program, PS was used as the weight, and the inverse probabilities weighting (IPW) model was used to generate a weighted cohort.ResultsIn total, 4,188 cases were included, with 2,174 (51.9%) in the propofol group and 2,014 (48.1%) in the midazolam group. In the PS score matching cohort, the 28-day mortality of patients in the midazolam group was 30.8%, and the 28-day mortality of patients in the propofol group was 25.5%. The adjusted odds ratio (OR) value was 1.421 [95% confidence interval (CI): 1.118–1.806, P<0.001]. Patients in the propofol group did not use vasoactive drugs for a longer period of time than the midazolam group, and patients in the propofol group received significantly more fluids than those in the midazolam group in the first three days after admission to the ICU.ConclusionsCompared with midazolam combined with fentanyl, propofol combined with fentanyl for sedation and analgesia can reduce the risk of short-term death in ICU patients.

High-Fidelity Simulation-Based Education: Description of an Original Crisis Resource Management and Sedation Learning for Dental Surgeons.

Dental surgery includes invasive procedures performed under sedation or monitored anesthesia care (MAC). It is associated with respiratory risks, resulting in death or neurological sequelae without prompt and appropriate management. Management of airway complications also implies mastering crisis resource management (CRM) principles, essentially non-technical skills to improve patient safety. In response to the need to enhance patient safety and to securely perform surgical procedures outside the operating room due to reduced surgical activity during the worldwide spread of the COVID-19 pandemic, we realized, in our simulation center, a course based on high fidelity simulation to teach procedural sedation and management of related complications. The simulation center accredited this educational program as a continuing professional development formation. The course includes technical skills practice, theoretical presentation, and mastering non-technical skills related to CRM principles. This brief report describes a relatively innovative teaching technique in dentistry, highlights its interest, and reports the subjective opinion of learners as to the pedagogical and professional impact of this training. A learner’s satisfaction survey supports the utility of our sedation and CRM programs. A high degree of satisfaction and perceived value reflect robust learners’ engagement. All medical specialties should encourage high-fidelity simulation continuing professional development courses that incorporate technical skills and crisis management principles.

Creation and Implementation of a Hospitalist-Run Propofol Sedation Program.

Pediatric hospitalists increasingly provide sedation outside the operating room. Given the large body of safety data available, propofol was identified as a beneficial addition to our hospitalist-run sedation service's medication repertoire. Currently, the training required for hospitalists to provide sedation is defined and determined locally by individual institutions. We convened a task force to develop and implement training for hospitalists in the use of propofol for deep sedation. After implementing training, we analyzed the outcome of patients receiving propofol for deep sedation for MRI, including the adverse event rate and successful completion rate. An adverse event was defined as a significant desaturation, persistent upper airway obstruction, laryngospasm, administration of neuromuscular blockade, conversion to anesthesia, call for additional backup, or if the procedure was not able to be completed. Successful completion was defined as any patient being able to complete the imaging study or procedure with sedation performed by a hospitalist physician. Between September 2015 and September 2018, sedation services sedated 12 979 patients, 3929 of whom were deeply sedated with propofol. During this period, the trained hospitalists had an adverse event rate of 3.6% and a 98.9% rate of successful completion of all studies or procedures when using propofol for deep sedation. With a comprehensive training program for hospitalists in the administration of propofol, we provided effective sedation for a selective population of patients. We now have a standard approach that uses credentialed hospitalists to train new faculty for propofol administration.

Increasing the Utilization of Moderate Sedation Services for Pediatric Imaging.

Performing motion-free imaging is frequently challenging in children. To bridge the gap between examinations performed in children who are awake and in those under general anesthesia, a moderate sedation program was implemented at our institution but was seldom used despite substantial eligibility. In conjunction with a 5-month quality improvement (QI) course, a multidisciplinary team was assembled and, by using an A3 approach, sought to address the most important key drivers of low utilization, namely the need for clear moderate sedation eligibility criteria, reliable protocol routing order, consistent moderate sedation screening performed by registered nurses (RNs), and enhanced visibility of moderate sedation services to ordering providers. Initial steps focused on developing better-defined criteria and protocoling standard work for technologists and RNs, with coaching and audits. Modality-specific forecasting was then implemented to reroute profiles of patients who were awaiting scheduling or already scheduled for an examination with general anesthesia to the moderate sedation queue to identify more eligible patients. These manual efforts were coupled with higher reliability but more protracted electronic health record changes, facilitating automated protocol routing on the basis of moderate sedation eligibility and order entry constraints. As a result, scheduled imaging examinations requiring moderate sedation increased from a mean of 1.2 examinations per week to a sustained 6.1 examinations per week (range, 4-8) over the 5-month period, exceeding the team SMART (specific, measurable, achievable, relevant, and time bound) goal to achieve an average of five examinations per week by the QI course end. By targeting the most high-impact yet modifiable process deficiencies through a multifaceted team approach and initially investing in manual efforts to gain cultural buy-in while awaiting higher-reliability interventions, the project achieved success and may serve as a more general model for workflow change when there is organizational resistance. ©RSNA, 2021.

Propofol sedation administered by cardiologists in echocardiography studies

Introduction and objectivesThe advantages of sedation in patients undergoing transesophageal echocardiography (TEE) are well established, but the increasing number of TEE studies may limit the capacity of anesthesiology services. In this study we analyze the effectiveness and safety of a moderate sedation program carried out by non-anesthesiology professionals (NAP). MethodsDescriptive and prospective study that included all consecutive patients undergoing a TEE procedure under moderate sedation by NAP and by anesthesiology professionals (AP) from September 2018 to September 2019. Patients were selected according to a specific algorithm agreed upon with the Anesthesiology Department. We analyze current indications for TEE, complication rates, and recovery times associated with sedation. ResultsWe performed 267 procedures in 252 patients (54% male, 69 years). Main indications were screening or monitoring of surgical and percutaneous cardiac interventions (47.9%), endocarditis (28.5%) and stroke (20.6%). Patients in the NAP group were younger (59 vs 71 years), less hypertensive (43% vs 61%), with less lung disease (4% vs 24%), lower risk of difficult airway (1% vs 22%) and lower comorbidity (ASA scale≥III 13% vs 77%). Complications were more frequent in the AP group (26% vs 9%), mainly mild respiratory (19% vs 9%). Events were associated with the presence of lung disease and higher ASA degree. Recovery time was longer in the AP sedation group (20min vs 15min). ConclusionsTEE indications are changing and involve larger and more complex studies. Moderate sedation with propofol performed by NAP is safe in selected patients, with adequate recovery times.

Safety and efficacy of remimazolam in high risk colonoscopy: A randomized trial

BackgroundProcedural sedation of ASA III/IV patients has increased risk. Remimazolam (an ultra-short-acting benzodiazepine) has proven safe and efficient for outpatient colonoscopy sedation. MethodsA double-blind, randomized, multi-center, parallel group trial was performed, comparing remimazolam to placebo with an additional open-label arm for midazolam in procedural sedation of 79 ASA III/IV patients undergoing colonoscopy. This was the third of 3 Phase III trials for remimazolam in the procedural sedation program. The primary end point was the safety of remimazolam. ResultsOf 79 patients randomized at 3 US sites, 77 underwent sedation and colonoscopy (31 received remimazolam, 16 placebo and 30 midazolam). Incidence and frequency of treatment emergent adverse events (TEAEs) were comparable in all three treatment arms, and independent of ASA status. One TEAE leading to discontinuation and one serious TEAE were reported; both in the open label midazolam arm. The efficacy endpoint was achieved for remimazolam, placebo, and midazolam in 87.1%, 0%, and 13.3% of patients (p<0.00001 for remimazolam versus placebo and versus midazolam, respectively). ConclusionsRemimazolam is safe and efficient in procedural sedation of high risk ASA patients undergoing colonoscopy, showing a safety profile comparable to that in low risk ASA.

A Pediatric Nurse Practitioner–Led Moderate Sedation Service: Our 7-Year Experience

The use of moderate sedation in children for the performance of a variety of diagnostic imaging tests and therapeutic interventions outside of the operating room, not directly supervised by an anesthesiologist, has been successful and well-documented in recent years. However, to date, all published reports describe only physicians as the primary provider performing the moderate sedation. In this article, we discuss our development of a nurse practitioner (NP)-led pediatric sedation program and a 7-year review of practice. We discuss the development of our NP-led team including key elements such as necessary personnel, process components, and guidelines for pharmacologic agents. We also present our practice outcomes, demonstrating an annual increase in patient volumes, a procedure success rate of 99.5%, and the occurrence of no major adverse events. NPs are an effective, safe alternative to physicians as the primary provider for this specialty service.

606 Establishing a Deep Sedation Program: Challenges and Successes from a Nursing Management Perspective

Abstract Introduction A burn center with a high volume of burn admissions was looking for ways to decrease the pain and anxiety experienced by patients during wound care. Patients requiring surgical dressing removal or demonstrating difficulty in coping during wound care were of particular concern. Discussions between anesthesia providers and the burn team led to the concept of anesthesia safely providing deep sedation in the inpatient wound care center for select dressing changes. Nursing management began to work through the challenges of implementing the Burn Center Deep Sedation Program. Methods Processes for identifying, scheduling, and recovering patients were established. All Burn Acute Care Unit (BACU) patients requiring a surgical dressing removal or demonstrating poor coping during wound care would qualify for deep sedation. Nursing management worked to create an online scheduling system, and designated a room which was set up with anesthesia equipment and supplies. Candidates were reviewed for deep sedation and a schedule created for the following day. All patients required a Burn Intensive Care Unit (BICU) nurse during the recovery period. A BICU room adjacent to the wound care center became the deep sedation recovery room, and was staffed by the BICU charge nurse. BICU nurses received additional training in post anesthesia care prior to the program implementation. Once all educational needs and logistical changes were addressed, the deep sedation program began operating seven days per week. Results Starting in January 2016 deep sedation has been provided to approximately 400 cases per year. No additional staff was required, only shifting responsibilities of existing nursing personnel. Designating a specific room for deep sedation has ensured that anesthesia providers have access to the appropriate equipment and has minimized disruptions to the flow of other dressing changes occurring throughout the day. The impact of the program on pain and anxiety is currently under evaluation. Informal feedback from patients and staff members has been very positive. Conclusions The challenge in developing this program was the amount of education and planning required prior to implementation. Once the program was active, the challenges that occurred involved the scheduling system. An additional benefit of the program was the teamwork required between BICU and BACU nurses to safely handoff patients. The deep sedation program has also strengthened the burn team’s relationship with the anesthesia providers, whose commitment to the project was appreciated by all involved. A team approach and a collective mission to improve care for burn patients have driven this project to its current success. Applicability of Research to Practice The collaboration between the burn team and anesthesia has resulted in an improved wound care experience for the patient.

A 3-Year Review of an Outpatient Burn Sedation Program in a Tertiary Burn Care Centre: Is It Safe and Does It Work?

The burn treatment room at our tertiary-care centre is run by a multidisciplinary team, providing care to primarily burn patients who require moderate to deep sedation to undergo dressing changes in a monitored setting outside the operating room. There is little literature on the safety, efficacy, and logistics of treating outpatient pediatric burn patients in this manner. This study reviews the safety of deep sedation in the burn treatment room. A retrospective chart review of patients with burns treated in the burn treatment room from 2013 to 2015 was conducted. Patient demographics, diagnosis, procedure details, sedation, and adverse events were recorded. Data were analyzed descriptively. Sevety-four patients with burns had a total of 308 visits in the burn treatment room for burn bath and/or dressing changes. Scald burns were the most common mechanism of injury (n = 56). Most burns were superficial and mid-dermal (54%), initially estimated at 5% to 10% TBSA (50%). Of the 308 visits, 304 required sedation. Adverse events were recorded in 11 (3.6%) of 304 sedated procedures. None of these events were critical: 7 patients required intravenous conversion due to inadequate oral sedation, 2 experienced brief apnea episodes but recovered spontaneously, and 2 had delayed discharge of more than 2 hours due to residual sedation. The burn treatment room is a safe and effective setting for treating pediatric burn patients, bypassing what might historically require operating suite inpatient management.

Sedation in the Intensive Care Setting

The recent clinical trials on sedation and delirium in the ICU shifted the scales dramatically in the past 10 to 20 years and less sedation is now the accepted norm with titration goals. Now the art of sedation is in the hands of the clinicians to achieve a balance between alleviation of pain and anxiety while keeping patients calm, cooperative, and part of daily activities in the ICU. In this chapter we summarize the various assessment tools for optimal sedation in the ICU as well as the medications used to achieve sedation. However, the clinicians should not forget the nonpharmacologic approaches such as prevention of sleep interruption as part of a successful comprehensive sedation program in the ICU. This review contains 3 tables, and 22 references. Key Words: confusion assessment method, delirium, dexmedetomidine, etomidate, fentanyl, GABA, ketamine, propofol, Richmond agitation-sedation scale (RASS), sedation-agitation scale (SAS)

Sedation in the Intensive Care Setting

The recent clinical trials on sedation and delirium in the ICU shifted the scales dramatically in the past 10 to 20 years and less sedation is now the accepted norm with titration goals. Now the art of sedation is in the hands of the clinicians to achieve a balance between alleviation of pain and anxiety while keeping patients calm, cooperative, and part of daily activities in the ICU. In this chapter we summarize the various assessment tools for optimal sedation in the ICU as well as the medications used to achieve sedation. However, the clinicians should not forget the nonpharmacologic approaches such as prevention of sleep interruption as part of a successful comprehensive sedation program in the ICU. This review contains 3 tables, and 22 references. Key Words: confusion assessment method, delirium, dexmedetomidine, etomidate, fentanyl, GABA, ketamine, propofol, Richmond agitation-sedation scale (RASS), sedation-agitation scale (SAS)

Sedation in the Intensive Care Setting

The recent clinical trials on sedation and delirium in the ICU shifted the scales dramatically in the past 10 to 20 years and less sedation is now the accepted norm with titration goals. Now the art of sedation is in the hands of the clinicians to achieve a balance between alleviation of pain and anxiety while keeping patients calm, cooperative, and part of daily activities in the ICU. In this chapter we summarize the various assessment tools for optimal sedation in the ICU as well as the medications used to achieve sedation. However, the clinicians should not forget the nonpharmacologic approaches such as prevention of sleep interruption as part of a successful comprehensive sedation program in the ICU. This review contains 3 tables, and 22 references. Key Words: confusion assessment method, delirium, dexmedetomidine, etomidate, fentanyl, GABA, ketamine, propofol, Richmond agitation-sedation scale (RASS), sedation-agitation scale (SAS)

Sedation in the Intensive Care Setting

The recent clinical trials on sedation and delirium in the ICU shifted the scales dramatically in the past 10 to 20 years and less sedation is now the accepted norm with titration goals. Now the art of sedation is in the hands of the clinicians to achieve a balance between alleviation of pain and anxiety while keeping patients calm, cooperative, and part of daily activities in the ICU. In this chapter we summarize the various assessment tools for optimal sedation in the ICU as well as the medications used to achieve sedation. However, the clinicians should not forget the nonpharmacologic approaches such as prevention of sleep interruption as part of a successful comprehensive sedation program in the ICU. This review contains 3 tables, and 22 references. Key Words: confusion assessment method, delirium, dexmedetomidine, etomidate, fentanyl, GABA, ketamine, propofol, Richmond agitation-sedation scale (RASS), sedation-agitation scale (SAS)

Safety and Efficacy of Buccal Dexmedetomidine for MRI Sedation in School-Aged Children.

Intranasal, intramuscular, and intravenous (IV) dexmedetomidine routes have been used successfully for pediatric MRI studies. We designed this retrospective study to determine efficacy and safety of buccal dexmedetomidine for pediatric MRI sedation. Medical records were reviewed of outpatient children ages 5 to 18 years who received buccal dexmedetomidine with or without oral midazolam for MRI sedation at a freestanding children's hospital sedation program in 2015 and 2016. A total of 220 outpatient encounters received buccal dexmedetomidine for MRI. Mean age of the cohort was 10.1 ± 2.6 years (range: 5-18.7). Buccal dexmedetomidine dose administered was a mean of 2.20 ± 0.38 μg/kg (range: 0.88-3.19). Of the 220 sedation encounters, 179 (81.4%) patients had satisfactory sedation with buccal dexmedetomidine with or without oral midazolam: 84 had buccal dexmedetomidine as the sole sedative, 95 had satisfactory sedation when buccal dexmedetomidine and oral midazolam (mean: 0.33 ± 0.07 mg/kg; range: 0.21-0.53) were given together, 1 (0.4%) had satisfactory sedation when intranasal fentanyl and midazolam were administered in addition to buccal dexmedetomidine, and 35 (15.9%) required IV sedatives to achieve satisfactory sedation. All patients completed their MRI successfully except 5 (2.2%): 2 encounters were sedation failures, 2 IV sedations developed severe upper airway obstruction, and 1 IV sedation experienced MRI contrast anaphylaxis. In a selected population of pediatric patients, buccal dexmedetomidine with or without midazolam provides adequate sedation for most MRI studies with few adverse effects, but given a failure rate of almost 20%, modifications to buccal dexmedetomidine dosing should be investigated.

The utility of the pretracheal stethoscope in detecting ventilatory abnormalities during propofol sedation in children.

Monitoring of ventilation with capnography or a stethoscope is recommended because the detection of ventilatory abnormalities can be significantly delayed by the use of pulse oximetry alone in patients receiving supplemental oxygen. The aim of this study was to evaluate the diagnostic performance of the pretracheal stethoscope with pulse oximetry and capnography in detecting adverse respiratory events during propofol sedation in nonintubated children. We hypothesized that use of the pretracheal stethoscope would facilitate earlier detection of adverse respiratory events. This was a prospectiveobservational study of children undergoing procedural sedation at a pediatric sedation program. A pretracheal stethoscope, pulse oximetry, and nasal capnography were attached at the discretion of the sedation nurse and provider to monitor ventilation. We enrolled 104 patient encounters (mean recorded time, SD 8.3±5.3minutes) from February, 2015 to March, 2017. The pretracheal stethoscope was the first monitor to detect adverse events in 64% (25/39) of patients compared to 18% (7/39) for capnography and 15% (6/39) for pulse oximetry. Auscultation performed best at detecting upper airway obstruction but capnography and pulse oximetry performed best at detecting hypoventilation. The positive predictive value for detecting a true ventilation abnormality and 95% CI of the pretracheal stethoscope, pulse oximetry, and capnography was 100% (90%-100%), 18% (10%-31%), and 27% (18%-38%), respectively. The negative predictive value and 95% CI of the pretracheal stethoscope, pulse oximetry, and capnography was 88% (82%-92%), 68% (59%-75%), and 70% (61%-78%), respectively. Limitations are short observation time, nonstandardized application of respiratory monitors, and too much focus on auscultation. A pretracheal stethoscope in conjunction with capnography and pulse oximetry detects most sedation-related adverse events first. Auscultation performed best at detecting upper airway obstruction but capnography and pulse oximetry performed best at detecting hypoventilation.

Safety and efficacy of applying sufficient analgesia combined with a minimal sedation program as an early antihypertensive treatment for spontaneous intracerebral hemorrhage: a randomized controlled trial

BackgroundSpontaneous intracerebral hemorrhage (ICH) is a serious threat to human health. Although early blood pressure (BP) elevation is closely associated with a poor prognosis, the optimal antihypertensive regimen for acute-phase ICH remains controversial. In ICH, pain, sleep deprivation, and stress are usually the main causes of dramatic BP increases. While traditional antihypertensive treatment resolves the increased BP, it does not address the root cause of the disease. Remifentanil relieves pain and, when combined with dexmedetomidine’s antisympathetic action, can restore elevated BP to normal levels. Here, we seek to validate the efficacy and safety of applying sufficient analgesia in combination with a minimal sedation program versus antihypertensive drug therapy for the early and rapid stabilization of BP in ICH patients.Methods/designWe are conducting a multicenter, prospective, randomized controlled, single-blinded, superiority clinical trial across 15 hospitals. We will enroll 354 subjects in mainland China, and all subjects will be randomized into experimental and control groups in which they will be given remifentanil combined with dexmedetomidine or antihypertensive drugs (urapidil, nicardipine, and labetalol). The primary endpoint will be the systolic BP control rate within 1 h of treatment initiation, and the efficacy and safety of the antihypertensive regimens will be compared between the two groups. Secondary endpoints include the incidence rate of early hemorrhage growth, neurological function, duration of intensive care unit (ICU) stay, and staff satisfaction with the treatment process.DiscussionWe hypothesize that applying sufficient analgesia in combination with minimal sedation will act as an effective and safe antihypertensive strategy in ICH and that this treatment strategy could, therefore, be widely used as an ICH acute-phase therapy.Trial registrationClinicalTrials.gov, ID: NCT03207100. Registered on 22 July 2017.

Procedural sedation in children with autism spectrum disorders: A survey of current practice patterns of the society for pediatric sedation members.

Children with autism spectrum disorder are challenging to sedate because of communication, sensory, and behavioral challenges. The aim of this survey was to determine how procedural sedation is provided to children with autism spectrum disorders and whether sedation programs have specialized protocols for procedural sedation of these children. We surveyed physician Medical Directors of sedation programs who are members of the Society for Pediatric Sedation, asking about practice characteristics and resource utilization during procedural sedation of children with autism spectrum disorders. Of 58 directors, 47 (81%) responded. Of the programs surveyed, 53% were either a large university medical center and 40% were a freestanding children's hospital. Only (12/47, 25.5%) of the programs used an individualized autism coping plan. To accomplish procedural sedation in this study cohort, 36% of the programs used additional nurses, whereas a child life specialist was used in 55% of the programs surveyed. Only 28% of the centers allotted additional time to accommodate children with autism spectrum disorders. Distraction methods were used in 80% whereas restrains were used in 45% programs for were used most commonly for i.v. catheter placement. Propofol was the preferred agent for 70% of programs for imaging, while propofol + fentanyl was used by 66% of programs for painful procedures. Although 57% of directors reported that their program staff was extremely comfortable providing procedural sedation for children with autism spectrum disorder, 79% of the directors wanted more education about behavioral management strategies for procedural sedation of these children. Among the Society for Pediatric Sedation programs, significant institutional variation exists on the delivery of procedural sedation to children with autism spectrum disorders. A better understanding of resources required, standardization of behavioral management strategies and pharmacologic approaches, and protocol development may help optimize care to this vulnerable population.