Pub Date : 2018-10-01DOI: 10.1093/MED/9780190659110.003.0014
Melissa L. Langhan, S. Wolf
There is a lack of data about the benefits of cardiovascular monitoring with continuous 3-lead electrocardiography (ECG) and intermittent noninvasive cuff blood pressure (BP) during procedural sedation and analgesia (PSA) in the pediatric population. However, these two safe modalities are important for patients during higher levels of PSA because of the risk of rare life-threatening conditions and to help identify possible medication side effects and drug interactions of common sedative medications. These monitoring modalities can also aid in determining the adequacy of sedation. It is generally accepted that a baseline determination of heart rate and BP should be obtained prior to any sedative administration. With deeper levels of sedation and throughout recovery, continuous 3-lead ECG and intermittent BP monitoring are recommended, in addition to other modalities such as pulse oximetry and capnography, to monitor the safety of the patient.
{"title":"Noninvasive Blood Pressure Monitoring and Electrocardiography","authors":"Melissa L. Langhan, S. Wolf","doi":"10.1093/MED/9780190659110.003.0014","DOIUrl":"https://doi.org/10.1093/MED/9780190659110.003.0014","url":null,"abstract":"There is a lack of data about the benefits of cardiovascular monitoring with continuous 3-lead electrocardiography (ECG) and intermittent noninvasive cuff blood pressure (BP) during procedural sedation and analgesia (PSA) in the pediatric population. However, these two safe modalities are important for patients during higher levels of PSA because of the risk of rare life-threatening conditions and to help identify possible medication side effects and drug interactions of common sedative medications. These monitoring modalities can also aid in determining the adequacy of sedation. It is generally accepted that a baseline determination of heart rate and BP should be obtained prior to any sedative administration. With deeper levels of sedation and throughout recovery, continuous 3-lead ECG and intermittent BP monitoring are recommended, in addition to other modalities such as pulse oximetry and capnography, to monitor the safety of the patient.","PeriodicalId":188400,"journal":{"name":"The Pediatric Procedural Sedation Handbook","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127112653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED/9780190659110.003.0005
Lowell Clark, Stephen Tomek
The practice of procedural sedation involves the use of medications that alter upper airway function and patency because of myoneural suppression of anatomic airway elements. It is the specific responsibility of the sedationist to ensure upper airway patency during conditions induced by pharmaceuticals in which the airway is almost certain to be threatened, if not totally obstructed. Soft tissue collapse during inspiration is modeled by the Starling resistor. Airway protective reflexes may be profoundly disturbed during deep sedation. The sedationist’s knowledge of the anatomy and physiology of the upper airway and proficiency in clinical application of airway supportive principles are essential.
{"title":"The Pediatric Airway","authors":"Lowell Clark, Stephen Tomek","doi":"10.1093/MED/9780190659110.003.0005","DOIUrl":"https://doi.org/10.1093/MED/9780190659110.003.0005","url":null,"abstract":"The practice of procedural sedation involves the use of medications that alter upper airway function and patency because of myoneural suppression of anatomic airway elements. It is the specific responsibility of the sedationist to ensure upper airway patency during conditions induced by pharmaceuticals in which the airway is almost certain to be threatened, if not totally obstructed. Soft tissue collapse during inspiration is modeled by the Starling resistor. Airway protective reflexes may be profoundly disturbed during deep sedation. The sedationist’s knowledge of the anatomy and physiology of the upper airway and proficiency in clinical application of airway supportive principles are essential.","PeriodicalId":188400,"journal":{"name":"The Pediatric Procedural Sedation Handbook","volume":"100 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116433186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/med/9780190659110.003.0059
J. Tobias, G. Hollman
Given the complexity of the knowledge and skills required for the safe conduct of pediatric sedation, compounded by the diversity of sedation practitioners, a formal process for training and credentialing is recommended. Credentialing and recredentialing are the processes by which hospitals collect and review a practitioner’s qualifications as part of the initial step in granting clinical privileges. Regulatory boards mandate that each institution have a system in place that defines qualification requirements and approval of privileges for clinical practices such as procedural sedation. The credentialing process recurs at 2- to 3-year intervals along with renewal of privileges. Recredentialing of privileges may differ from the initial process.
{"title":"Credentialing and Recredentialing for Pediatric Sedation","authors":"J. Tobias, G. Hollman","doi":"10.1093/med/9780190659110.003.0059","DOIUrl":"https://doi.org/10.1093/med/9780190659110.003.0059","url":null,"abstract":"Given the complexity of the knowledge and skills required for the safe conduct of pediatric sedation, compounded by the diversity of sedation practitioners, a formal process for training and credentialing is recommended. Credentialing and recredentialing are the processes by which hospitals collect and review a practitioner’s qualifications as part of the initial step in granting clinical privileges. Regulatory boards mandate that each institution have a system in place that defines qualification requirements and approval of privileges for clinical practices such as procedural sedation. The credentialing process recurs at 2- to 3-year intervals along with renewal of privileges. Recredentialing of privileges may differ from the initial process.","PeriodicalId":188400,"journal":{"name":"The Pediatric Procedural Sedation Handbook","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124138411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/med/9780190659110.003.0035
Bryan P McKee, N. Johnson
Radiation therapy is a therapeutic option in the treatment of many childhood cancers. It involves the use of high-energy waves and/or matter that injure and kill cancer cells. Radiation therapy may be delivered to a patient via external, internal, and systemic methods. Procedural sedation is most frequently requested for external radiation therapy. Regardless of the method of external radiation used, patient immobility contributes greatly to successful therapy. The goal of the sedationist in the management of a child undergoing radiation therapy is to maintain the optimal environment in terms of patient safety and immobility so that the radiation oncology team can provide the most effective treatment.
{"title":"Radiation Therapy","authors":"Bryan P McKee, N. Johnson","doi":"10.1093/med/9780190659110.003.0035","DOIUrl":"https://doi.org/10.1093/med/9780190659110.003.0035","url":null,"abstract":"Radiation therapy is a therapeutic option in the treatment of many childhood cancers. It involves the use of high-energy waves and/or matter that injure and kill cancer cells. Radiation therapy may be delivered to a patient via external, internal, and systemic methods. Procedural sedation is most frequently requested for external radiation therapy. Regardless of the method of external radiation used, patient immobility contributes greatly to successful therapy. The goal of the sedationist in the management of a child undergoing radiation therapy is to maintain the optimal environment in terms of patient safety and immobility so that the radiation oncology team can provide the most effective treatment.","PeriodicalId":188400,"journal":{"name":"The Pediatric Procedural Sedation Handbook","volume":"129 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131162916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/med/9780190659110.003.0054
Michelle M. Rhoads, E. Briening, N. Crego, Kimberly Paula-Santos, Lauren Huster
The nursing process can be used in the safe and effective delivery of pediatric sedation care. Nurses contribute to the direct care of sedated patients by developing competency and expanding knowledge and expertise within their specialty. While the provision of care to patients and families is of paramount importance, ensuring an environment conducive to delivery of safe, quality care by the healthcare team is another fundamental aspect of nursing. Management of sedation, analgesia, and anxiety in pediatric procedural sedation is an intrinsically multidisciplinary process that involves nursing, physicians, child life specialists, and other healthcare providers. In general, pediatric procedural sedation is a relatively new specialty with limited data on the role of the pediatric nurse in this multiprofessional team. It is an opportunity for nursing to collaborate with other healthcare professionals to establish guidelines and protocols to facilitate optimal patient care and efficiency as well as to share and expand their knowledge base and clinical skill set. Specialty certification and credentialing, team concept values, and the evolving role of the sedation nurse are all elements to consider within pediatric procedural sedation from the nursing perspective.
{"title":"Nursing Perspective","authors":"Michelle M. Rhoads, E. Briening, N. Crego, Kimberly Paula-Santos, Lauren Huster","doi":"10.1093/med/9780190659110.003.0054","DOIUrl":"https://doi.org/10.1093/med/9780190659110.003.0054","url":null,"abstract":"The nursing process can be used in the safe and effective delivery of pediatric sedation care. Nurses contribute to the direct care of sedated patients by developing competency and expanding knowledge and expertise within their specialty. While the provision of care to patients and families is of paramount importance, ensuring an environment conducive to delivery of safe, quality care by the healthcare team is another fundamental aspect of nursing. Management of sedation, analgesia, and anxiety in pediatric procedural sedation is an intrinsically multidisciplinary process that involves nursing, physicians, child life specialists, and other healthcare providers. In general, pediatric procedural sedation is a relatively new specialty with limited data on the role of the pediatric nurse in this multiprofessional team. It is an opportunity for nursing to collaborate with other healthcare professionals to establish guidelines and protocols to facilitate optimal patient care and efficiency as well as to share and expand their knowledge base and clinical skill set. Specialty certification and credentialing, team concept values, and the evolving role of the sedation nurse are all elements to consider within pediatric procedural sedation from the nursing perspective.","PeriodicalId":188400,"journal":{"name":"The Pediatric Procedural Sedation Handbook","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133001366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED/9780190659110.003.0013
M. Bhatt, M. Roback
There is a documented increase in the risk of aspiration of stomach contents during airway management for general anesthesia. This risk of a serious complication has resulted in strict regulatory recommendations concerning preprocedural fasting even for moderate and deep sedation. The physiology and evidence for fasting recommendations before procedural sedation care in children are discussed here.
{"title":"Fasting and Aspiration Risk in Procedural Sedation","authors":"M. Bhatt, M. Roback","doi":"10.1093/MED/9780190659110.003.0013","DOIUrl":"https://doi.org/10.1093/MED/9780190659110.003.0013","url":null,"abstract":"There is a documented increase in the risk of aspiration of stomach contents during airway management for general anesthesia. This risk of a serious complication has resulted in strict regulatory recommendations concerning preprocedural fasting even for moderate and deep sedation. The physiology and evidence for fasting recommendations before procedural sedation care in children are discussed here.","PeriodicalId":188400,"journal":{"name":"The Pediatric Procedural Sedation Handbook","volume":"136 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115559514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED/9780190659110.003.0058
D. Banks, D. Werner
The sustainability of a sedation service depends on its ability to generate revenue, both for the providers and for the facility/institution. A complete understanding of the process of coding and billing to achieve maximum reimbursement is necessary for planning a new sedation service, as well as maintaining and expanding an existing one. This section discusses CPT coding and billing for deep sedation, moderate sedation, provider consulting, and facility fees. Coding and billing for deep sedation involves using CPT codes for anesthesia services. Coding and billing for moderate sedation involves the use of the moderate sedation CPT codes that were updated for 2017. Coding and billing for hospital services associated with providing deep sedation involves the use of facility revenue codes.
{"title":"Hospital and Professional Reimbursement","authors":"D. Banks, D. Werner","doi":"10.1093/MED/9780190659110.003.0058","DOIUrl":"https://doi.org/10.1093/MED/9780190659110.003.0058","url":null,"abstract":"The sustainability of a sedation service depends on its ability to generate revenue, both for the providers and for the facility/institution. A complete understanding of the process of coding and billing to achieve maximum reimbursement is necessary for planning a new sedation service, as well as maintaining and expanding an existing one. This section discusses CPT coding and billing for deep sedation, moderate sedation, provider consulting, and facility fees. Coding and billing for deep sedation involves using CPT codes for anesthesia services. Coding and billing for moderate sedation involves the use of the moderate sedation CPT codes that were updated for 2017. Coding and billing for hospital services associated with providing deep sedation involves the use of facility revenue codes.","PeriodicalId":188400,"journal":{"name":"The Pediatric Procedural Sedation Handbook","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114939430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/med/9780190659110.003.0028
Kimberly L. Fugok, S. Kost
Appropriately skilled personnel, equipment, and organized space should be in place prior to the initiation of a sedated procedure. The use of procedural carts or kits for commonly performed procedures can increase safety and efficiency. The intended level of sedation should be appropriate for the procedure, with the understanding that not every procedural situation is predictable. In the setting of a sedation service, matching provider level to sedation level can improve the efficiency of the service. In settings where sedationist and proceduralist are one and the same, the presence of another clinician dedicated solely to monitoring the patient and assisting in rescue is essential. Preparation and organization of the sedation/procedural room, maximizing flow for the scheduled event, will expedite care. The personal safety of the sedation staff should be considered during the procedural event.
{"title":"Procedural Aspects Affecting Sedation Care","authors":"Kimberly L. Fugok, S. Kost","doi":"10.1093/med/9780190659110.003.0028","DOIUrl":"https://doi.org/10.1093/med/9780190659110.003.0028","url":null,"abstract":"Appropriately skilled personnel, equipment, and organized space should be in place prior to the initiation of a sedated procedure. The use of procedural carts or kits for commonly performed procedures can increase safety and efficiency. The intended level of sedation should be appropriate for the procedure, with the understanding that not every procedural situation is predictable. In the setting of a sedation service, matching provider level to sedation level can improve the efficiency of the service. In settings where sedationist and proceduralist are one and the same, the presence of another clinician dedicated solely to monitoring the patient and assisting in rescue is essential. Preparation and organization of the sedation/procedural room, maximizing flow for the scheduled event, will expedite care. The personal safety of the sedation staff should be considered during the procedural event.","PeriodicalId":188400,"journal":{"name":"The Pediatric Procedural Sedation Handbook","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123697179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED/9780190659110.003.0026
Chris A. Rees, C. Chumpitazi
Sedation in pediatric patients can lead to decreased muscle tone and subsequent tissue relaxation and airway narrowing. Thus, sedated children are at risk of respiratory depression, laryngospasm, airway obstruction, apnea, and loss of airway reflexes. Hypotension and cardiopulmonary arrest may also occur, although these complications usually result from failure to recognize and correct respiratory compromise. Despite careful presedation assessment, appropriate medication and dose selection, and appropriate cardiovascular monitoring during the procedure, the risks associated with sedation cannot be eliminated entirely. As it is common for children to pass from the intended level of sedation to deeper levels of sedation, providers should be capable of providing appropriate rescue interventions from one level of sedation deeper than what is intended. Algorithms for response to monitored changes in ventilation and oxygenation are presented that can aid the sedationist in responding effectively to an event, preventing the spiral to a condition producing lasting harm to the patient.
{"title":"Methods of Rescue/Response","authors":"Chris A. Rees, C. Chumpitazi","doi":"10.1093/MED/9780190659110.003.0026","DOIUrl":"https://doi.org/10.1093/MED/9780190659110.003.0026","url":null,"abstract":"Sedation in pediatric patients can lead to decreased muscle tone and subsequent tissue relaxation and airway narrowing. Thus, sedated children are at risk of respiratory depression, laryngospasm, airway obstruction, apnea, and loss of airway reflexes. Hypotension and cardiopulmonary arrest may also occur, although these complications usually result from failure to recognize and correct respiratory compromise. Despite careful presedation assessment, appropriate medication and dose selection, and appropriate cardiovascular monitoring during the procedure, the risks associated with sedation cannot be eliminated entirely. As it is common for children to pass from the intended level of sedation to deeper levels of sedation, providers should be capable of providing appropriate rescue interventions from one level of sedation deeper than what is intended. Algorithms for response to monitored changes in ventilation and oxygenation are presented that can aid the sedationist in responding effectively to an event, preventing the spiral to a condition producing lasting harm to the patient.","PeriodicalId":188400,"journal":{"name":"The Pediatric Procedural Sedation Handbook","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129553434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED/9780190659110.003.0060
J. Kopec
The concept of a pediatric sedation unit developed as the need for a sedation service outside of the operating room became legitimized and essential to hospitals with a large pediatric population. The pediatric sedation unit is an area of a hospital specifically designed and staffed to provide safe sedation to children for invasive and noninvasive procedures outside of the operating room. A well-organized unit offers many benefits to the hospital, including efficiency, cost savings, and patient/family/provider satisfaction. The unit’s design and administration will vary based on the local medical climate and needs of a given region. The unit is highly integrated into the hospital and, once established, is virtually essential to the provision of safe and efficient care of children. Integration with the hospital, study modalities, and subspecialties can be facilitated by easy access to the unit for inpatients and outpatients, enhanced communication using the electronic medical record, an organized scheduling and screening process, and attention to improvement and growth.
{"title":"A Sedation Unit Approach","authors":"J. Kopec","doi":"10.1093/MED/9780190659110.003.0060","DOIUrl":"https://doi.org/10.1093/MED/9780190659110.003.0060","url":null,"abstract":"The concept of a pediatric sedation unit developed as the need for a sedation service outside of the operating room became legitimized and essential to hospitals with a large pediatric population. The pediatric sedation unit is an area of a hospital specifically designed and staffed to provide safe sedation to children for invasive and noninvasive procedures outside of the operating room. A well-organized unit offers many benefits to the hospital, including efficiency, cost savings, and patient/family/provider satisfaction. The unit’s design and administration will vary based on the local medical climate and needs of a given region. The unit is highly integrated into the hospital and, once established, is virtually essential to the provision of safe and efficient care of children. Integration with the hospital, study modalities, and subspecialties can be facilitated by easy access to the unit for inpatients and outpatients, enhanced communication using the electronic medical record, an organized scheduling and screening process, and attention to improvement and growth.","PeriodicalId":188400,"journal":{"name":"The Pediatric Procedural Sedation Handbook","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122574203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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