Efficacy Outcome Measures for Pediatric Procedural Sedation Clinical Trials: An ACTTION Systematic Review.

Objective evaluations comparing different techniques and approaches to pediatric procedural sedation studies have been limited by a lack of consistency among the outcome measures used in assessment. This study reviewed those existing measures, which have undergone psychometric analysis in a pediatric procedural sedation setting, to determine to what extent and in what circumstances their use is justified across the spectrum of procedures, age groups, and techniques. The results of our study suggest that a wide range of measures has been used to assess the efficacy and effectiveness of pediatric procedural sedation.

Update on pharmacological management of procedural sedation for children.

Purpose Of Review: The review provides an update on pharmacological techniques for procedural sedation for children outside the operating room.

Recent Findings: An increasing number of studies of propofol, ketamine, nitrous oxide, dexmedetomidine, and intranasal administration of drugs for procedural sedation of children continue to be reported.

Summary: Propofol and ketamine are commonly used for procedural sedation in children and the use of dexmedetomidine and nitrous oxide is increasing.

Variation in Procedural Sedation Practices Among Children's Hospitals.

Background And Objective: Children often need procedural sedation for painful procedures. There are few data on type of provider, site of sedation, and agents used for procedural sedation in hospitals across the nation. The objective was to determine procedural sedation practices for hospitalized children outside the PICU and emergency department.

Pediatric sedation.

Pediatric sedation is an evolving field performed by an extensive list of specialties. Well-defined sedation systems within pediatric facilities are paramount to providing consistent, safe sedation. Pediatric sedation providers should be trained in the principles and practice of sedation, which include patient selection, pre-sedation assessment to determine risks during sedation, selection of optimal sedation medication, monitoring requirements, and post-sedation care.

A proposed mechanism to assess knowledge of pediatric hospitalists to identify and manage rare events during procedural sedation.

Objective: The goal of this study was to assess the knowledge of pediatric hospitalists (PHs) in identifying and managing rare events during procedural sedation (PS) with ketamine and nitrous oxide (N2O).

Methods: A Web-based survey with multiple choice questions and case scenarios was used to determine the knowledge of PHs in identifying infrequent contraindications and managing laryngospasm, a rare life-threatening complication during PS. The survey was sent to all PHs at St Louis Children's Hospital.

Procedural sedation by pediatric hospitalists: analysis of the nature and incidence of complications during ketamine and nitrous oxide sedation.

Objective: The goal of this study was to determine the nature and rate of complications during procedural sedation by pediatric hospitalists (PH) using ketamine and nitrous oxide (N2O).

Methods: This study was a retrospective review and analysis of a quality improvement database for sedations performed by PH at St Louis Children's Hospital from February 2007 to February 2013. Information was obtained on sedations performed and reported in the quality improvement database by PH over this time period using ketamine and N2O.

Successful implementation of a referral-based academic pediatric hospitalist service.

Objective: St Louis Children's Hospital (SLCH) developed Service for Hospital Admissions by Referring Physicians (SHARP) in January 2008 as an inpatient referral service for pediatricians who previously admitted their own patients. We hypothesized that use of SHARP would make hospitalization more efficient and cost-effective compared with the general pediatric medicine (GM) service.

Methods: Admission volumes, diagnoses, length of stay (LOS), costs, and physician billing data were abstracted from SLCH information systems and the Pediatric Health Information System database.

Procedural sedation for diagnostic imaging in children by pediatric hospitalists using propofol: analysis of the nature, frequency, and predictors of adverse events and interventions.

Objective: To evaluate the nature, frequency, and predictors of adverse events during the use of propofol by pediatric hospitalists.

Study Design: We reviewed 1649 charts of patients sedated with propofol by pediatric hospitalists at St Louis Children's Hospital between January 2005 and September 2009.

Results: Hospitalists were able to complete 1633 of the 1649 sedations reviewed (99%).

Development of a pediatric hospitalist sedation service: training and implementation.

Objective: There is growing demand for safe and effective procedural sedation in pediatric facilities nationally. Currently, these needs are being met by a variety of providers and sedation techniques, including anesthesiologists, pediatric intensivists, emergency medicine physicians, and pediatric hospitalists. There is currently no consensus regarding the training required by non-anesthesiologists to provide safe sedation.

The use of high-dose epinephrine for patients with out-of-hospital cardiopulmonary arrest refractory to prehospital interventions.

Objective: To determine if high-dose epinephrine (HDE) used during out-of-hospital cardiopulmonary arrest refractory to prehospital interventions improves return of spontaneous circulation, 24-hour survival, discharge survival, and neurological outcomes.

Methods: A multicenter randomized controlled trial was conducted between May 1991 and October 1996 to compare the effectiveness of HDE versus standard-dose epinephrine (SDE) in patients having out-of-hospital cardiopulmonary arrest refractory to prehospital resuscitation efforts. Cardiopulmonary arrest was classified as "medical" or "traumatic.

Pediatric hospitalists fill varied roles in the care of newborns.

The use of hospitalists in the care of newborns appears to be increasing and may be advantageous for several reasons, including decreased cost, decreased length of stay, increased patient survival, increased availability, and greater experience among hospitalists. Research specific to the use of hospitalists in newborn medicine needs to be done to support this hypothesis. Non-clinical activities such as teaching, developing clinical guidelines, and taking an active role in hospital and academic leadership also may improve education and patient care.