Adherence to safety guidelines on paediatric procedural sedation: the results of a nationwide survey under general paediatricians in The Netherlands

Leroy, Piet L. J. M.; Nieman, Fred; Blokland-Loggers, H E; Schipper, Daphne M; Zimmermann, Luc J. I.; Knape, J. T. A.

doi:10.1136/adc.2009.165647

Cited by 13 publications

(11 citation statements)

References 11 publications

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“…However, despite the availability of guidelines, PS practice is still unsafe in many settings and adherence to guidelines among nonanesthesiologists has been reported to be low [ 16 , 17 ]. It has been argued that guidelines on PS produced by consensus between anesthesiologists (rather than on evidence-based guidelines by the clinicians themselves) have caused confusion and variation in practices [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Professional Skills and Competence for Safe and Effective Procedural Sedation in Children: Recommendations Based on a Systematic Review of the Literature

Leroy

Schipper

Knape

2010

International Journal of Pediatrics

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Objectives. To investigate which skills and competence are imperative to assure optimal effectiveness and safety of procedural sedation (PS) in children and to analyze the underlying levels of evidence. Study Design and methods. Systematic review of literature published between 1993 and March 2009. Selected papers were classified according to their methodological quality and summarized in evidence-based conclusions. Next, conclusions were used to formulate recommendations. Results. Although the safety profiles vary among PS drugs, the possibility of potentially serious adverse events and the predictability of depth and duration of sedation define the imperative skills and competence necessary for a timely recognition and appropriate management. The level of effectiveness is mainly determined by the ability to apply titratable PS, including deep sedation using short-acting anesthetics for invasive procedures and nitrous oxide for minor painful procedures, and the implementation of non-pharmacological techniques. Conclusions. PS related safety and effectiveness are determined by the circumstances and professional skills rather than by specific pharmacologic characteristics. Evidence based recommendations regarding necessary skills and competence should be used to set up training programs and to define which professionals can and cannot be credentialed for PS in children.

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Section: Introductionmentioning

confidence: 99%

Professional Skills and Competence for Safe and Effective Procedural Sedation in Children: Recommendations Based on a Systematic Review of the Literature

Leroy

Schipper

Knape

2010

International Journal of Pediatrics

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“…Evidence-based guidelines for physiologic monitoring during sedation may be difficult to develop. 6,28 In some settings (eg, the magnetic resonance imaging scanner), the environment itself may challenge the accuracy of many monitoring modalities. In other situations, the use of monitors themselves (eg, blood pressure cuffs) can disturb the sedated child and interfere with procedures that require absolute motion control.…”

Section: Commentmentioning

confidence: 99%

Physiologic Monitoring Practices During Pediatric Procedural Sedation

Langhan

Mallory²,

Hertzog³

et al. 2012

Arch Pediatr Adolesc Med

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To describe the frequency of different physiologic monitoring modalities and combinations of modalities used during pediatric procedural sedation; to describe how physiologic monitoring varies among different classes of patients, health care providers (ie, ranging from anesthesiologists to emergency medicine physicians to nurse practitioners), procedures, and sedative medications employed; and to determine the proportion of sedations meeting published guidelines for physiologic monitoring.

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“…Het is aangetoond dat in Nederland essentiële veiligheidsrichtlijnen ten aanzien van PS onvoldoende geïmplementeerd zijn op de werkvloer. 10 Ook de matige effectiviteit van vele PSprotocollen baart zorgen. De geringe voorspelbaarheid van vaak gebruikte sedativa en de beperkte competenties bij niet-anesthesiologen leiden ertoe dat MRI-onderzoeken regelmatig mislukken.…”

Section: Inleidingunclassified

“…In de studie van Mallory kwamen desaturaties in 1,22% van het aantal PS voor en moest in 0,32% worden geïntervenieerd met masker en ballon. Heard 10 Van alle PS-medicatie die in Nederland beschikbaar is, blijkt een diepe sedatie met propofol de hoogste mate van effectiviteit te hebben. In vergelijking met algemene anesthesie is de kans op succes even hoog zonder de noodzaak tot intubatie.…”

Section: Propofolunclassified