We typically stay in the room through the procedure, presumably including
the time of peak effect, giving us the opportunity to more closely time
administration of the sedating agent(s) and directly observe both the
intended and unintended effects. It is a major consumption of ED
attending time, but it is also one of the things we do which sets us
apart in many ways.
We have recently had a lot of attention focused on conscious sedation in
preparation for JCAHO next fall. The hospital has produced a rather
formal document, in concert with the faculty, which is intended to ensure
a similar level of care everywhere in the institution. Two aspects of the
dcoument have generated much discussion. The first is that physicians
must be specifically privileged to perform conscious sedation. The
second aspects is that a physician privileged to perform conscious
sedation must be in the room, or on the unit and immediately available,
during the procedure. This clearly has a major impact on inpatient units
in the middle of the night, and on neuroimaging procedures managed by
senior residents. Anyone have similar requirements? If so, how are you
Thanks for the discussion. This is what the PED-EM-L ought to be like.
Makes me want to turn on the computer.
Allen R. Walker, M.D.
Pediatric Emergency Medicine