In our institution, for deep sedation, the person doing the procedure cannot be the person providing deep sedation. Meticulous attention needs to be paid to airway/respiratory management at all times and this is best done by a physician who is expert in this so that subtle changes can be identified and managed before the patient deteriorates. This is particularly true in that the threshold between deep sedation and gen anesthesia can be crossed inadvertently.
We have a nurse also who primarily documents and does some monitoring and is there to help out in the event there is a significant event related to the sedation.
Elise W. van der Jagt, MD, MPH, FAAP, SFHM
Professor of Pediatrics and Critical Care
Pediatric Sedation Officer
Chief, Pediatric Hospital Medicine
University of Rochester Medical Center
601 Elmwood Ave., Box 667
Rochester, NY 14642
Golisano Children's Hospital
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Bernard Dannenberg
Sent: Tuesday, November 18, 2014 7:09 PM
To: [log in to unmask]
Subject: Deep (Procedural) Sedation in the Pediatric ED, one vs two physician presence
A straw poll to all members
We have written a new policy for deep sedation in our Pediatric Emergency Department.
The following sentence has raised significant resistance by our anesthesia department:
> The physician administering deep sedation may also perform the procedure if a qualified ED registered nurse (RN) is present to continuously monitor the patient.
Their argument is that not one academic institution they contacted would permit this.
Naturally I am suspicious. CMS guidelines appear to allow that one provider can administer the sedation if a qualified nurse is present to monitor the patient.
The California Department of Public Health has issued the following clarification in July 2013 https://urldefense.proofpoint.com/v2/url?u=http-3A__www.cdph.ca.gov_certlic_facilities_Documents_LNC-2DAFL-2D13-2D17.pdf&d=AAIFaQ&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLUQRxhA&r=U8mD137vcSlcKJYPnZ2lgpiN1pKg9W8j4g606YTHprDbGeReCmYTGhJOFWn9rqv-&m=nAJc9v539AzNX6PTrjik2nVyHLg8AdmP-MQiy0rthzc&s=eos1ZIVa3Prq-_oQ4gAvwTw-eB-NwpF62CMB2lD60wE&e=
Can you respond to me directly what your institution is allowing you to do.
A. 2 physicians need to be present: One performs the sedation, the other performs the procedure
B. 1 physician can administer the sedation and perform the procedure if a qualified RN is monitoring the patient
I will tabulate the answers and distribute them back to the group.
Thank you for your assistance
Bernard Dannenberg, MD, FAAP, FACEP
Clinical Associate Professor
Davies Family Director, Pediatric Emergency Medicine Division of Emergency Medicine Department of Surgery Stanford University School of Medicine Lucile Packard Children’s Hospital
300 Pasteur Drive
Alway Building M-121
Stanford, CA 94305
(650) 721 2450 FAX: (650) 723-0121
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