Lalwani Kirk, Michel Marlon
Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
Paediatr Anaesth. 2005 Mar;15(3):209-13. doi: 10.1111/j.1460-9592.2005.01437.x.
Information about the existence and organization of pediatric sedation services in North America is not available. We conducted a survey to collect this information from anesthesiologists at pediatric institutions and to identify factors perceived as limiting the development of sedation services.
We electronically mailed a confidential survey about pediatric sedation practice to an attending anesthesiologist involved in pediatric sedation at 116 children's hospitals in the United States and Canada. We identified the institutions using Internet resources. Electronic mailing addresses were obtained from departmental websites, society membership directories and departmental administrators. Our follow-up for nonresponders was by a second e-mail and a telephone call.
A total of 54 completed questionnaires were received, a response rate of 47%. Forty-nine (91%) were received from US hospitals, and the remainder from Canadian. Fifty percent of hospitals had a formal pediatric sedation service. Fifty-four percent utilized a 'mobile' provider model. Hospital credentialing for nonanesthesiologist providers varied between 66 and 76% for 'deep' and 'conscious' sedation, respectively. A nurse-physician provider combination was the most common, utilized in 59% of hospitals. Anesthesiologists were the sole sedation providers in 26% of institutions. Propofol was used regularly by nonanesthesiologists for sedation of nonintubated (42%) and intubated (63%) patients. Eighty-seven percent of institutions reported barriers to development of pediatric sedation services. The most common barrier was a shortage of providers, particularly anesthesiologists.
Propofol use by nonanesthesiologists is common. Addressing the shortage of providers, and allocating resources for credentialing providers will encourage further development of pediatric sedation practice.
北美地区儿科镇静服务的存在情况及组织形式尚无相关信息。我们开展了一项调查，旨在从儿科机构的麻醉医生处收集此类信息，并确定被认为限制镇静服务发展的因素。
我们通过电子邮件向美国和加拿大116家儿童医院中参与儿科镇静工作的主治麻醉医生发送了一份关于儿科镇静实践的保密调查问卷。我们利用互联网资源确定了这些机构。电子邮件地址从部门网站、协会会员名录和部门管理人员处获取。对于未回复者，我们通过第二次电子邮件和电话进行跟进。
共收到54份完整问卷，回复率为47%。其中49份（91%）来自美国医院，其余来自加拿大医院。50%的医院设有正式的儿科镇静服务。54%采用“流动”提供者模式。非麻醉医生提供者的医院资质认证，“深度”镇静和“清醒”镇静分别在66%至76%之间。护士 - 医生的提供者组合最为常见，59%的医院采用。26%的机构中麻醉医生是唯一的镇静提供者。非麻醉医生经常使用丙泊酚对未插管（42%）和插管（63%）患者进行镇静。87%的机构报告了儿科镇静服务发展的障碍。最常见的障碍是提供者短缺，尤其是麻醉医生。
非麻醉医生使用丙泊酚的情况很常见。解决提供者短缺问题，并为提供者资质认证分配资源，将有助于推动儿科镇静实践的进一步发展。
