Presentation of a Sedation Standard Using the Example of Transesophageal Echocardiographies (TEE) in Pediatric Outpatients

Abstract

Most pediatric patients require deep sedation for a TEE examination. We analyzed the data of our sedation protocols relating to all outpatient TEEs in patients under 18 years of age for the year 2011. On the basis of the data records of a total of 40 patients, we will describe our standard and compare it with the findings of the international literature. In a retrospective analysis, we inspected our sedation protocols in terms of patient-related data, vital parameters, drug applications, occurring complications and necessary interventions as well as nausea and vomiting during the post-sedative monitoring phase. In line with our standard, we applied atropine, midazolam, S-ketamine and propofol; complications occurred in 5 patients. They could be handled using simple measures. With regard to the vital parameters, no severe complications occurred. Dizziness was observed in 4 patients during the recovery phase; one patient complained about nausea and vomiting during the first fluid intake. All patients could be discharged 4 h after the termination of sedation. Our standard is a practicable and safe procedure for preforming TEE examinations in pediatric outpatients.

Analgosedation for diagnostic and interventional procedures: a countrywide survey of pediatric centers in Germany

“…What remains generally unanswered is the question just how much training should be required from an anesthesiologist or pediatrician to be considered "experienced enough" for safe delivery of a sedation, regardless of its depth [14]. While we have repeatedly reported on the good experience with our own in-house standard [5,6,22,23], any wholesale extrapolation of this experience and its analysis would be misguided, given that other pediatric centers may have training programs that differ from ours in content and emphasis. Further corroboration of the above points comes from impressive evidence by Hoffmann et al [24] for an association between rigorous adherence to predefined standards and complication rates.…”