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Yes, as long as the likely effects are consistently obtained without
tipping over into unsafe territory.  I would add that it is the effects that
one obtains with sedative-hypnotics or opioids which should determine
the vigorousness of monitoring required.  However, what seems
abundantly clear from the literature in children is that agent, dosage, and
route of adminstration are important predictors of serious complications
reported with these agents.
 
I think what we are trying to achieve (for example, a calmer, less
anxious, more cooperative child in the case of an otherwise
uncomplicated laceration repair) or the objectives of our sedation should
be made clear to patients, caretakers, and staff.  This may help us to
better define guidelines which are best for all of our patients.
 
Tom Terndrup, MD
 
>>> Allen Walker MD <[log in to unmask]>
08/21/96 02:17am >>>
I would agree with Dr. Christopher. The effect one seeks (or is likely to
get) ought to be what determines the level of monitoring necessary, not
the agent, the route, or the dose.
 
Myron Yaster and Lynne Maxwell present a challenge to all of us in their
thoughtful editorial in Archives of Pediatric and Adolescent Medicine this
month. There is quite a mythology to "conscious sedation", and we need
to demythologize so that we can continue to provide safe sedation and
pain relief to children.
 
Allen R. Walker, MD
Director, Pediatric Emergency Medicine
Johns Hopkins
 
 
 
On Mon, 19 Aug 1996, Norman C. Christopher, MD wrote:
 
> I am concerned when "conscious sedation" is defined more by the
chosen agent
> than by the anticipated or likely effects of the agent. At ineffective or
> subtherapeutic doses, NO agent will imply risk to protective reflexes,
while
> at excessive doses, even anxiolytics and narcotics will.
>
> Norman C. Christopher, MD
> Director, Emergency/Trauma Services
> Children's Hospital Medical Center of Akron
>
>
> At 12:11 AM 8/16/96 -0700, you wrote:
> >At our institution, we monitor kids who get po Versed only with a
> >pulse ox.  We tried to present a protocol to the Pharmacy & Thera-
> >peutics committee, and they basically said this is not even conscious
> >sedation, it's just an anxiolytic, so you don't need a conscious
> >sedation protocol.  In contrary, we have an extensive protocol for
> >IV or IM ketamine, including q5 min vitals during and q15min during
> >recovery time, EKG and pulse ox monitoring,  informed consent, etc.
> >Of course, we can get a complicated lac in a small kid done a lot
> >better with ketamine than po versed!
> >
> >Kelly Young
> >PEM Fellow
> >
>
>======================================================================
> >Kelly  D. Young, MD                                Tel: (310) 222-3501
> >Dept of Emergency Medicine                         Msg: (310) 222-5383
> >Harbor-UCLA Medical Center, Box 21                 Fax: (310) 782-1763
> >1000 West Carson Street
> >Torrance, CA 90509                      email: [log in to unmask]
>
>======================================================================
> >
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> >
> >
>
> For help send e-mail to: [log in to unmask]
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