Problemi non correnti
Unità di sedazione pediatrica per procedure diagnostiche dolorose
PAEDIATRIC TASK FORCE FOR SEDATION IN PAINFUL DIAGNOSTIC PROCEDURES
E. BARBI, M. PENNESI, A. SARTI1, I. BRUNO, E. NERI, T. PAHOR, G. TORRE, S. MARTELOSSI, P. TAMARO, M. RABUSIN, F. BALSEMIN, M. FILAFERRO, A. VENTURA
Clinica Pediatrica, 1Servizio di Anestesia e Rianimazione, IRCCS “Burlo Garofolo”, Trieste
Giugno 2001 - pagg. 369 -375
Abstract
Particularly in tertiary care centres, there is an increased need for diagnostic procedures,
such as CT scans, magnetic resonance, endoscopies, lumbar punctures, biopsies, etc., which
require different degrees of anesthesia and/or sedation of the child to ensure safety and
performance and to avoid unnecessary pain and discomfort. The limited availability of
anestesiologists often represents a problem, leading to unnecessary waiting time. For this
reason paediatricians and nurses with specific training in intensive care are increasingly
involved in providing sedation for diagnostic procedures. Safety concerns have been voiced
and discussed about the use of a variety of drugs and procedures. The Authors report
their one-year experience in a tertiary care paediatric hospital regarding in-ward sedation
for non invasive (such as diagnostic imaging) or moderately invasive (such as endoscopies
and biopsies) procedures. Propofol was used for moderately invasive procedures. A small
task force (2 paediatrician and 2 nurses) was established to ensure continuity and good
performance. The experience has been satisfactory in terms of efficacy, safety and cost and
has been positively evaluated by both patients and health professionals.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Practice guidelines for sedation and analgesia
by non-anesthesiologists: a report by
the American Society of Anesthesiologist Task
Force on Sedation and analgesia by Non
Anesthesiologists. Anesthesiology 1995;84:
459-71.
2. Reyle-Hahn M, Niggeman B, Max M, et al. Remifentanyl and propofol for sedation in children and young adolescents undergoing diagnostic flexible bronchoscopy. Paediatr Anaesth 2000;10(1):59-63.
3. Reinhold P, Graichen B. Propofol for sedation in pediatric magnetic resonance imaging investigations. Klin Padiatr 1999;211(1): 40-3.
4. Havel CJ Jr, Strait RT, Hennes H. A clinical trial of propofol vs midazolam for procedural sedation in a pediatric emergency department. Acad Emerg Med 1999;6(10):989- 97.
5. Bauman LA, Kish I, Baumann RC, Politis GD. Pediatric sedation with analgesia. Am J Emerg Med 1999;17(1):1-3.
6. Krauss B, Green SM. Sedation and analgesia for procedures in children. N Eng J Med 2000;342(13):938-45.
7. Nadwindy LA. The use of propofol versus diazepam-meperidine for pediatric gastrointestinal endoscopic procedures. North America Society for Pediatric Gastroenterology. 7 th Annual Meeting, 1993.
8. Hertzog JH, Campbell JK, Dalton HJ, Hauser GJ. Propofol anesthesia for invasive procedures in ambulatory and hospitalized children: experience in the pediatric intensive care unit. Pediatrics 1999;103(3):E30.
9. Hertzog JH, Dalton HJ, Anderson BD, Shad AT, Gootenberg JE, Hauser GJ. Prospective evaluation of propofol anesthesia in the pediatric intensive care unit for elective oncology procedures in ambulatory and hospitalized children. Pediatrics 2000;106(4): 742-7.
10. Coté CJ. Sedation for the pediatric patient. A review. Ped Clin North Am (February 94), Pediatric anesthesia. Wetzel Philadelphia, RC Guest (ed), vol 41 (1), pp 31- 58, Feb 1994. WB Saunders Company.
11. Orfei P, Ianesi HM, Patrizio A, Bigetti E, et al. Propofol for paediatric gastrointestinal endoscopy. J Pediatr 2000;26:139.
12. Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anest Analg 2000;90(4): 963-9.
13. Roy L. Sedation, analgesia and anesthesia for painful or frightening procedures outside the operating room. In: Bridgwell JM (ed). Clinical Pediatric Anesthesia. Philadelphia: Lippinat-Raven, 1997:435-59.
14. Martin LD, Paternak LR, Pudimat MA. Total intravenous anesthesia with propofol in pediatric patients outside the operating room. Anest Analg 1992;74:609-12.
15. Sury MR, Hatch DJ, Deeley T, et al. Development of a nurse-led sedation service for paediatric magnetic resonance imaging. Lancet 1999;353:1667-71.
16. Coté CJ, Notterman DA, Karl HW, Weinberg JA, McCloskey C. Diverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics 2000; 105:805-14.
2. Reyle-Hahn M, Niggeman B, Max M, et al. Remifentanyl and propofol for sedation in children and young adolescents undergoing diagnostic flexible bronchoscopy. Paediatr Anaesth 2000;10(1):59-63.
3. Reinhold P, Graichen B. Propofol for sedation in pediatric magnetic resonance imaging investigations. Klin Padiatr 1999;211(1): 40-3.
4. Havel CJ Jr, Strait RT, Hennes H. A clinical trial of propofol vs midazolam for procedural sedation in a pediatric emergency department. Acad Emerg Med 1999;6(10):989- 97.
5. Bauman LA, Kish I, Baumann RC, Politis GD. Pediatric sedation with analgesia. Am J Emerg Med 1999;17(1):1-3.
6. Krauss B, Green SM. Sedation and analgesia for procedures in children. N Eng J Med 2000;342(13):938-45.
7. Nadwindy LA. The use of propofol versus diazepam-meperidine for pediatric gastrointestinal endoscopic procedures. North America Society for Pediatric Gastroenterology. 7 th Annual Meeting, 1993.
8. Hertzog JH, Campbell JK, Dalton HJ, Hauser GJ. Propofol anesthesia for invasive procedures in ambulatory and hospitalized children: experience in the pediatric intensive care unit. Pediatrics 1999;103(3):E30.
9. Hertzog JH, Dalton HJ, Anderson BD, Shad AT, Gootenberg JE, Hauser GJ. Prospective evaluation of propofol anesthesia in the pediatric intensive care unit for elective oncology procedures in ambulatory and hospitalized children. Pediatrics 2000;106(4): 742-7.
10. Coté CJ. Sedation for the pediatric patient. A review. Ped Clin North Am (February 94), Pediatric anesthesia. Wetzel Philadelphia, RC Guest (ed), vol 41 (1), pp 31- 58, Feb 1994. WB Saunders Company.
11. Orfei P, Ianesi HM, Patrizio A, Bigetti E, et al. Propofol for paediatric gastrointestinal endoscopy. J Pediatr 2000;26:139.
12. Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anest Analg 2000;90(4): 963-9.
13. Roy L. Sedation, analgesia and anesthesia for painful or frightening procedures outside the operating room. In: Bridgwell JM (ed). Clinical Pediatric Anesthesia. Philadelphia: Lippinat-Raven, 1997:435-59.
14. Martin LD, Paternak LR, Pudimat MA. Total intravenous anesthesia with propofol in pediatric patients outside the operating room. Anest Analg 1992;74:609-12.
15. Sury MR, Hatch DJ, Deeley T, et al. Development of a nurse-led sedation service for paediatric magnetic resonance imaging. Lancet 1999;353:1667-71.
16. Coté CJ, Notterman DA, Karl HW, Weinberg JA, McCloskey C. Diverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics 2000; 105:805-14.