Pub Date : 2018-10-01DOI: 10.1093/med/9780190659110.003.0010
M. Buckmaster
Evaluation of patient risk is a critical aspect of the presedation phase of care. For scheduled procedures and tests, information obtained during the prescreening process is incorporated into the formal assessment of the patient at the time of the procedure. If the prescreening process has been sufficiently rigorous, the patient is likely to be appropriately prepared for sedation and the day-of-procedure evaluation (procedure screen) should be able to be done quickly, efficiently, and safely. The presedation evaluation represents the final step prior to the initiation of sedation. This is where all interval information and findings are fused to develop the overall sedation plan. Appropriate integration of a rigorous prescreening process with a careful presedation review allows for the most comprehensive and safe approach to pediatric procedural sedation. Specific patient conditions that pose additional significant risk during procedural sedation are further discussed.
{"title":"Risk Assessment","authors":"M. Buckmaster","doi":"10.1093/med/9780190659110.003.0010","DOIUrl":"https://doi.org/10.1093/med/9780190659110.003.0010","url":null,"abstract":"Evaluation of patient risk is a critical aspect of the presedation phase of care. For scheduled procedures and tests, information obtained during the prescreening process is incorporated into the formal assessment of the patient at the time of the procedure. If the prescreening process has been sufficiently rigorous, the patient is likely to be appropriately prepared for sedation and the day-of-procedure evaluation (procedure screen) should be able to be done quickly, efficiently, and safely. The presedation evaluation represents the final step prior to the initiation of sedation. This is where all interval information and findings are fused to develop the overall sedation plan. Appropriate integration of a rigorous prescreening process with a careful presedation review allows for the most comprehensive and safe approach to pediatric procedural sedation. Specific patient conditions that pose additional significant risk during procedural sedation are further discussed.","PeriodicalId":188400,"journal":{"name":"The Pediatric Procedural Sedation Handbook","volume":"3 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":"117067487","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/9780190659110.003.0039
Paul G. Smith
Sedation is used for virtually all children undergoing fiberoptic airway endoscopy. Because the sedating and procedural physicians “share the airway,” overlapping responsibilities necessitate coordination between them. This section describes the components of a directed preprocedural assessment, emphasizes the need for communication with the bronchoscopist, gives an overview of sedation options, and outlines anticipated complications. Procedural considerations for common FAE indications are highlighted, along with how they influence the choice of setting and sedation agents and methods. Use of short-acting and ultrashort-acting agents will be stressed, as they are ideal sedatives to allow rapid return of normal respiratory drive. Adjuvant medications to facilitate the procedure will also be reviewed.
{"title":"Pulmonary","authors":"Paul G. Smith","doi":"10.1093/med/9780190659110.003.0039","DOIUrl":"https://doi.org/10.1093/med/9780190659110.003.0039","url":null,"abstract":"Sedation is used for virtually all children undergoing fiberoptic airway endoscopy. Because the sedating and procedural physicians “share the airway,” overlapping responsibilities necessitate coordination between them. This section describes the components of a directed preprocedural assessment, emphasizes the need for communication with the bronchoscopist, gives an overview of sedation options, and outlines anticipated complications. Procedural considerations for common FAE indications are highlighted, along with how they influence the choice of setting and sedation agents and methods. Use of short-acting and ultrashort-acting agents will be stressed, as they are ideal sedatives to allow rapid return of normal respiratory drive. Adjuvant medications to facilitate the procedure will also be reviewed.","PeriodicalId":188400,"journal":{"name":"The Pediatric Procedural Sedation Handbook","volume":"38 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":"128778123","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/9780190659110.003.0024
C. Chumpitazi
The incidence of sedation-related adverse events depends on medication characteristics, procedure conditions, and preexisting patient physiologic and psychological conditions. Major adverse sedation-related events represent extreme physiologic change causing significant patient harm that may be long-lasting or permanent, particularly if responded to ineffectively by the sedationist. Large safety studies of pediatric sedation events suggest that events of this type occur very rarely when well-organized, equipped, and trained sedation teams are present. However, sporadic reports of death during pediatric sedation continue to surface, providing significant impetus for effective preparation and training for sedationists. Major adverse sedation-related events discussed here are aspiration, cardiovascular collapse, respiratory failure, and death.
{"title":"Major Adverse Events","authors":"C. Chumpitazi","doi":"10.1093/MED/9780190659110.003.0024","DOIUrl":"https://doi.org/10.1093/MED/9780190659110.003.0024","url":null,"abstract":"The incidence of sedation-related adverse events depends on medication characteristics, procedure conditions, and preexisting patient physiologic and psychological conditions. Major adverse sedation-related events represent extreme physiologic change causing significant patient harm that may be long-lasting or permanent, particularly if responded to ineffectively by the sedationist. Large safety studies of pediatric sedation events suggest that events of this type occur very rarely when well-organized, equipped, and trained sedation teams are present. However, sporadic reports of death during pediatric sedation continue to surface, providing significant impetus for effective preparation and training for sedationists. Major adverse sedation-related events discussed here are aspiration, cardiovascular collapse, respiratory failure, and death.","PeriodicalId":188400,"journal":{"name":"The Pediatric Procedural Sedation Handbook","volume":"62 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":"117049181","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/9780190659110.003.0042
J. Fine, Ndidi Nwokorie, L. Lowrie
Vascular access is necessary for routine and emergent care of patients for delivery of fluids and medications. The vascular access devices (VADs) discussed here include peripheral intravascular catheters, intraosseous needles, peripherally inserted central catheters (PICC lines), and central venous catheters. VAD insertion can be painful and frightening for children, and their inherently smaller anatomy may also make the procedure more challenging. Children often require behavioral modification as well as medications to control pain and anxiety in order to tolerate placement of VADs. The sedationist must have a good knowledge of the demands of the procedure, the patient’s level of cooperation and cognitive ability, and pharmacologic resources available to aid in the performance of the procedure.
{"title":"Intravascular Access","authors":"J. Fine, Ndidi Nwokorie, L. Lowrie","doi":"10.1093/med/9780190659110.003.0042","DOIUrl":"https://doi.org/10.1093/med/9780190659110.003.0042","url":null,"abstract":"Vascular access is necessary for routine and emergent care of patients for delivery of fluids and medications. The vascular access devices (VADs) discussed here include peripheral intravascular catheters, intraosseous needles, peripherally inserted central catheters (PICC lines), and central venous catheters. VAD insertion can be painful and frightening for children, and their inherently smaller anatomy may also make the procedure more challenging. Children often require behavioral modification as well as medications to control pain and anxiety in order to tolerate placement of VADs. The sedationist must have a good knowledge of the demands of the procedure, the patient’s level of cooperation and cognitive ability, and pharmacologic resources available to aid in the performance of the procedure.","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":"125877266","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/9780190659110.003.0052
Amy E. Vinson, C. Houck
Local anesthesia is an important part of pediatric procedural sedation. Not only does it allow for pain reduction during intravenous catheter placement, but it can also reduce the total amount of sedation that is required during painful procedures and minimize the need for postoperative analgesia. This chapter outlines the historical aspects of topical local anesthetic use in children. The benefits and risks of topical and subcutaneous local anesthetics during procedural sedation are reviewed. While the topical use of local anesthetics is generally safe, careful titration of dosage based on the patient’s age and weight and the drug’s side-effect profile is important to prevent toxicity. Current recommendations for the treatment of local anesthetic systemic toxicity are provided.
{"title":"Topical and Local Anesthetics","authors":"Amy E. Vinson, C. Houck","doi":"10.1093/med/9780190659110.003.0052","DOIUrl":"https://doi.org/10.1093/med/9780190659110.003.0052","url":null,"abstract":"Local anesthesia is an important part of pediatric procedural sedation. Not only does it allow for pain reduction during intravenous catheter placement, but it can also reduce the total amount of sedation that is required during painful procedures and minimize the need for postoperative analgesia. This chapter outlines the historical aspects of topical local anesthetic use in children. The benefits and risks of topical and subcutaneous local anesthetics during procedural sedation are reviewed. While the topical use of local anesthetics is generally safe, careful titration of dosage based on the patient’s age and weight and the drug’s side-effect profile is important to prevent toxicity. Current recommendations for the treatment of local anesthetic systemic toxicity are provided.","PeriodicalId":188400,"journal":{"name":"The Pediatric Procedural Sedation Handbook","volume":"3 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":"116857205","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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