Safety of deep sedation in young children with sickle cell disease: a retrospective cohort study.

Objective: To assess the rates and types of complications associated with deep sedation in children with sickle cell disease (SCD) and to explore potential risk factors.

Study Design: This was a retrospective cohort study of children with SCD and a comparison group of children without SCD who underwent magnetic resonance imaging with deep sedation. The rates of general and SCD-associated sedation complications were calculated, and potential associated clinical and laboratory variables were assessed.

Front-line ordering clinicians: matching workforce to workload.

Background: Matching workforce to workload is particularly important in healthcare delivery, where an excess of workload for the available workforce may negatively impact processes and outcomes of patient care and resident learning. Hospitals currently lack a means to measure and match dynamic workload and workforce factors.

Objectives: This article describes our work to develop and obtain consensus for use of an objective tool to dynamically match the front-line ordering clinician (FLOC) workforce to clinical workload in a variety of inpatient settings.

Development, implementation, and initial participant feedback of a pediatric sedation provider course.

Background: No standardized educational curriculum exists for pediatric sedation practitioners. We sought to describe the curriculum and implementation of a pediatric sedation provider course and assess learner satisfaction with the course curriculum.

Description: The course content was determined by formulating a needs assessment using published sedation guidelines, reports of sedation related adverse events, and a survey of sedation practitioners.

Assessing pediatric residents' clinical performance in procedural sedation: a simulation-based needs assessment.

Objectives: Our primary objective in this study was to perform a needs assessment of clinical performance during simulated procedural sedation (PS) by pediatric residents. Our secondary objective was to describe reported experience and confidence with PS during pediatric residency.

Methods: In this prospective observational cohort study, pediatric residents completed a survey of 15 Likert-scaled items pertaining to confidence in PS, followed by performance of a standardized, video-recorded simulated PS complicated by an adverse event (AE): apnea and desaturation.

CSF opening pressure in children with optic nerve head edema.

Background: We previously reported that an abnormal CSF opening pressure (OP) in children was greater than 28 cm H(2)O. Since elevated intracranial pressure can cause optic nerve head edema (ONHE), we would expect that most patients with ONHE would have an OP greater than 28 cm H(2)O. This study describes the range of OP for children with ONHE and compared them to age-matched controls without ONHE.

Patient position during lumbar puncture has no meaningful effect on cerebrospinal fluid opening pressure in children.

The recommendation to measure cerebrospinal fluid opening pressure in the extended, rather than the flexed lateral recumbent position to avoid false elevation of the opening pressure has not been formally evaluated in children. This single-center prospective cohort study includes 53 children who had their opening pressure measured in both the flexed and extended lateral recumbent positions prior to removing any cerebrospinal fluid (mean age = 11.7 years; 60% male).

Sedating patients for radiologic studies.

Many different practice models for radiology sedation can provide satisfactory patient care. Adherence to recognized safety standards and the training and experience of sedation providers are critical for a successful program. Pediatricians should develop an appreciation of safe practices in the radiologic environment and the requirements related to individual studies and procedures.

The pharmacology of sedation.

There is no single "miracle drug" for sedation. However, the range of available agents is broad and provides many safe and effective sedation options for medical procedures and studies. Providers of pediatric sedation should be thoroughly familiar with these agents.