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          In response to the above questions:
          Yes, we do stay in the room the entire time.
          On nights from 6p-11P, we have 2 attendings, and since this
          tend to be the busist time, one can often be available
          for the procedure, nursing however, can be a problem.
          After 11p is when a patient may have to wait until the
          attending or 3rd year is available. Regarding, the
          "cadillac treatment"- I agree that we should give this
          to our patients, but sometimes ortho requests IV
          sedation with both medications when only pain relief is
          required: nondisplaced fractures, hip spicas, so one
          medication (fentanyl) is given by the physician, monitoring
          is the same, as is nursing, but we may leave a bit
          earlier if the patient is doing OK (pain free but not too
          sleepy).
 
          Dr. Walker,
 
          We have used Nitronox as well, with variable results. It is
          very effective for older children who can hold the mask in
          place themselves (when they have had enough their grip
          loosens). For young children the mask presents a challenge
          as they get frightened and 1) tend to mouth breath-therefore
          the nasal mask is useless, and 2) you fight with them to
          keep the mask on, which usually results in a more anxious
          child and a dizzy staff-we have a scavenger system, but the
          person holding the mask tends to get a bit when the child
          doesn't.
 
                              Susan Fuchs, M.D.
                              Children's Hosp. Pittsburgh