King Wendalyn K, Stockwell Jana A, DeGuzman Michael A, Simon Harold K, Khan Naghma S
Department of Pediatrics, Emory University, Atlanta, GA, USA.
Acad Emerg Med. 2006 Jun;13(6):673-6. doi: 10.1197/j.aem.2006.01.022. Epub 2006 May 2.
Pediatric patients often require sedation for diagnostic procedures such as magnetic resonance imaging and computed tomography scanning. In October 2002, a dedicated sedation service was started at a tertiary care pediatric facility as a joint venture between pediatric emergency medicine and pediatric critical care medicine. Before this service, sedation was provided by the department of radiology by using a standard protocol, with high-risk patients and failed sedations referred for general anesthesia.
To describe the initial experience with a dedicated pediatric-sedation service.
This was a retrospective analysis of quality-assurance data collected on all sedations in the radiology department for 23-month periods before and after sedation-service implementation. Study variables were number and reasons for canceled or incomplete procedures, rates of referral for general anesthesia, rates of hypoxia, prolonged sedation, need for assisted ventilation, apnea, emesis, and paradoxical reaction to medication. Results are reported in odds ratios (OR) with 95% confidence intervals (95% CI).
Data from 5,444 sedations were analyzed; 2,148 before and 3,296 after sedation-service activation. Incomplete studies secondary to inadequate sedation decreased, from 2.7% before the service was created to 0.8% in the post-sedation-service period (OR, 0.29; 95% CI = 0.18 to 0.47). There also were decreases in cancellations caused by patient illness (3.8% vs. 0.6%; OR, 0.16; 95% CI = 0.10 to 0.27) and rates of hypoxia (8.8% vs. 4.6%; OR, 0.50; 95% CI = 0.40 to 0.63). There were no significant differences between the groups in rates of apnea, need for assisted ventilation, emesis, or prolonged sedation. The implementation of the sedation service also was associated with a decrease in both the number of patients referred to general anesthesia without a trial of sedation (from 2.1% to 0.1%; OR, 0.33; 95% CI = 0.06 to 1.46) and the total number of general anesthesia cases in the radiology department (from 7.5% to 4.4% of all patients requiring either sedation or anesthesia; OR, 0.56; 95% CI = 0.45 to 0.71).
The implementation of a dedicated pediatric-sedation service resulted in fewer incomplete studies related to inadequate sedation, in fewer canceled studies secondary to patient illness, in fewer referrals for general anesthesia, and in fewer recorded instances of sedation-associated hypoxia. These findings have important implications in terms of patient safety and resource utilization.
儿科患者在进行诸如磁共振成像和计算机断层扫描等诊断程序时通常需要镇静。2002年10月，一家三级护理儿科机构启动了一项专门的镇静服务，这是儿科急诊医学与儿科重症医学的合资项目。在这项服务开展之前，放射科按照标准方案提供镇静，高危患者和镇静失败的患者则转至全身麻醉科。
描述一项专门的儿科镇静服务的初步经验。
这是一项回顾性分析，对镇静服务实施前后23个月期间放射科所有镇静的质量保证数据进行了分析。研究变量包括取消或未完成程序的数量及原因、全身麻醉转诊率、低氧血症发生率、镇静时间延长、辅助通气需求、呼吸暂停、呕吐以及药物反常反应。结果以比值比（OR）及95%置信区间（95%CI）报告。
分析了5444例镇静的数据；其中2148例在镇静服务启动前，3296例在启动后。因镇静不足导致的未完成检查有所减少，从服务开展前的2.7%降至服务开展后的0.8%（OR为0.29；95%CI为0.18至0.47）。因患者病情导致的检查取消率也有所下降（3.8%对0.6%；OR为0.16；95%CI为0.10至0.27），低氧血症发生率也下降了（8.8%对4.6%；OR为0.50；95%CI为0.40至0.63）。两组在呼吸暂停、辅助通气需求、呕吐或镇静时间延长的发生率方面无显著差异。镇静服务的实施还与未尝试镇静就转至全身麻醉科的患者数量减少（从2.1%降至0.1%；OR为0.33；95%CI为0.06至1.46）以及放射科全身麻醉病例总数减少（从所有需要镇静或麻醉的患者的7.5%降至4.4%；OR为0.56；95%CI为0.45至0.71）相关。
实施专门的儿科镇静服务减少了因镇静不足导致的未完成检查、因患者病情导致的取消检查、全身麻醉转诊以及记录在案的与镇静相关的低氧血症病例。这些发现对患者安全和资源利用具有重要意义。
