Development of paediatric gastroenterologic procedural sedation unit (PPSU)

F. Balsemin, M. Filaferro, Egidio Barbi, F. Marchetti, T. Gerarduzzi, E. Neri, S. Martelossi, A. Sarti, A. Ventura

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The need to perform procedural sedation for children has increased in recent years. Anaesthesia resources, however, are limited, and non anaesiologists must use sedation frequently. Aims: to assess safety and efficacy of procedural sedation with propofol in a paediatric ward of a third level paediatric teaching hospital, with trained personnel and monitoring facilities, in a prospective study over 30 months. Methods: We organised an equip for paediatric sedation, guaranteeing a specific training. We proposed procedural sedation to all the children admitted, from January 1st 2000 to May 31st 2002, for gastrointestinal invasive procedures. All the parents accepted the procedures and subscribed an informed consent both for sedation and the procedures. We administer atropine (0.01 mg/kg IV) and propofol diluted with lignocaine 1 mg every 10 mg for the first syringe (injected slowly with an induction dose of 2 mg/kg in children up to 8 years of age and 1 mg/kg in older children in two minutes). Repeated dose of propofol was 0.5-1 mg/kg or continuos infusion at 6-9 mg/kg/hr. The sedation endpoint was the comfort of the patients, with a variable degree of sedation allowing a safe execution of the procedure ("procedural sedation"). A questionnaire to determine the opinion regard procedural sedation was administered to patients, parents and doctors. Results: we performed 562 procedures (Tab. IV). Sedation was achieved easily in all procedures. The rate of major desaturation was of 1.7% during gastroscopies, while just moderate desaturation happened during colonscopies. No laryngospasm was experimented during colonscopies, versus 9 patients who experimented laryngospasm undergoing gastroscopies (Tab. V). Conclusions: the development of a paediatric sedation unit with trained personnel in an appropriate environment has allowed us to significantly increase the number of procedures performed with sedation with an high level of satisfaction both for patients and operators along with a significant sparing of resources. The role of the nurses in the development of this program was central. In our experience propofol used by non-anaesthesiologic trained personnel has a very good safety profile for lower endoscopies. The safety profile for gastroscopies is, on the contrary, not so good and far more data are needed before assuming that propofol can be used in absolute safety by non-anaesthesiologists in this setting.

Original languageEnglish
JournalRivista Italiana di Nutrizione Parenterale ed Enterale
Volume20
Issue numberSUPPL. 4
Publication statusPublished - Jul 2002

Keywords

  • Gastroenterologic procedures
  • Propofol
  • Sedation
  • Trained personnel

ASJC Scopus subject areas

  • Food Science
  • Anatomy
  • Critical Care and Intensive Care Medicine
  • Nutrition and Dietetics

Fingerprint Dive into the research topics of 'Development of paediatric gastroenterologic procedural sedation unit (PPSU)'. Together they form a unique fingerprint.

Cite this