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  • 1
    Online Resource
    Online Resource
    INTRAVENOUS KETAMINE SEDATION FOR PEDIATRIC RENAL BIOPSIES. 2155
    Springer Science and Business Media LLC ; 1996
    In:  Pediatric Research Vol. 39 ( 1996-4), p. 362-362
    Details
    In: Pediatric Research, Springer Science and Business Media LLC, Vol. 39 ( 1996-4), p. 362-362
    Type of Medium: Online Resource
    ISSN: 0031-3998 , 1530-0447
    URL: Article
    DOI: 10.1203/00006450-199604001-02179
    Language: Unknown
    Publisher: Springer Science and Business Media LLC
    Publication Date: 1996
    detail.hit.zdb_id: 2031217-9
    SSG: 12
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  • 2
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    Online Resource
    Reducing Delays in a Pediatric Procedural Unit With Ultrasound-Guided Intravenous Line Insertion
    American Academy of Pediatrics (AAP) ; 2021
    In:  Hospital Pediatrics Vol. 11, No. 11 ( 2021-11-01), p. 1222-1228
    Details
    In: Hospital Pediatrics, American Academy of Pediatrics (AAP), Vol. 11, No. 11 ( 2021-11-01), p. 1222-1228
    Abstract: Delay in vascular access is a leading cause of procedure delay in our pediatric procedure and infusion center. Use of ultrasound decreases time to peripheral intravenous catheter (PIV) insertion; however, ultrasound availability in our center was limited to an external venous access team (VAT). The objective of this project was to reduce PIV-related delays by 25%. METHODS Stakeholders convened and theorized that creating a unit-based nurse team specializing in ultrasound-guided peripheral intravenous catheter (USgPIV) insertion would facilitate faster access and a reduction in delayed procedures. An initial plan-do-study-act cycle was performed, training 2 nurses in USgPIV placement. Subsequent cycles were focused on increasing availability of USgPIV-trained nurses. The outcome measure was the rate of procedures delayed by PIV placement, analyzed on a statistical process control U-chart. The process measure was the percentage of USgPIV placements requiring consultations to the VAT, analyzed on a statistical process control P-chart. The balancing measure was the success rate per method of insertion. Comparisons of success rates were conducted by using a χ2 test and Fisher’s exact test. RESULTS The mean rate of procedures delayed because of vascular access fell by special cause variation from 10.8% to 6.4%. The mean VAT consultation rate fell from 86.4% to 32.0%. The VAT had higher rates of overall success (100% vs 87%; P = .01) and first-attempt success (93% vs 77%; P = .03) compared with unit nurse USgPIV placement. CONCLUSIONS Unit-based USgPIV placement in a pediatric procedural center was successfully implemented, with a significant decline in procedures delayed by PIV access.
    Type of Medium: Online Resource
    ISSN: 2154-1663 , 2154-1671
    URL: Article
    DOI: 10.1542/hpeds.2021-005870
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2021
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  • 3
    Online Resource
    Online Resource
    Development, Implementation, and Initial Participant Feedback of a Pediatric Sedation Provider Course
    Informa UK Limited ; 2013
    In:  Teaching and Learning in Medicine Vol. 25, No. 3 ( 2013-07), p. 249-257
    Details
    In: Teaching and Learning in Medicine, Informa UK Limited, Vol. 25, No. 3 ( 2013-07), p. 249-257
    Type of Medium: Online Resource
    ISSN: 1040-1334 , 1532-8015
    URL: Article
    DOI: 10.1080/10401334.2013.797352
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2013
    SSG: 5,3
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  • 4
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    Current State of Institutional Privileging Profiles for Pediatric Procedural Sedation Providers
    American Academy of Pediatrics (AAP) ; 2015
    In:  Hospital Pediatrics Vol. 5, No. 9 ( 2015-09-01), p. 487-494
    Details
    In: Hospital Pediatrics, American Academy of Pediatrics (AAP), Vol. 5, No. 9 ( 2015-09-01), p. 487-494
    Abstract: Providers from a variety of training backgrounds and specialties provide procedural sedation at institutions in the United States. We sought to better understand the privileging patterns and practices for sedation providers. METHODS: Surveys were sent to 56 program directors belonging to the Society for Pediatric Sedation using Research Electronic Data Capture to 56 pediatric sedation programs. The survey was designed to gather information regarding characteristics of their sedation service and the privileging of their sedation providers. RESULTS: The overall response rate was 41 (73%) of 56. Most programs surveyed (81%) said their physicians provided sedation as a part of their primary subspecialty job description, and 17% had physicians whose sole practice was pediatric sedation and no longer practiced in their primary subspecialty. Fifty-one percent of surveyed sedation programs were within freestanding children’s hospitals and 61% receive oversight by the anesthesiology department at their institution. Eighty-one percent of the sedation programs require physicians to undergo special credentialing to provide sedation. Of these, 79% grant privileging through their primary specialty, whereas 39% require separate credentialing through sedation as a stand-alone section. For initial credentialing, requirements included completion of a pediatric sedation orientation and training packet (51% of programs), sedation training during fellowship (59%), and documentation of a specific number of pediatric procedural sedation cases (49%). CONCLUSIONS: In this survey of pediatric sedation programs belonging to the Society for Pediatric Sedation, the process for privileging providers in procedural sedation varies significantly from institution to institution. An opportunity exists to propose privileging standards for providers of pediatric procedural sedation.
    Type of Medium: Online Resource
    ISSN: 2154-1663 , 2154-1671
    URL: Article
    DOI: 10.1542/hpeds.2015-0052
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2015
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  • 5
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    Online Resource
    A retrospective comparison of propofol alone to propofol in combination with dexmedetomidine for pediatric 3T MRI sedation
    Wiley ; 2017
    In:  Pediatric Anesthesia Vol. 27, No. 1 ( 2017-01), p. 52-59
    Details
    In: Pediatric Anesthesia, Wiley, Vol. 27, No. 1 ( 2017-01), p. 52-59
    Abstract: Both propofol and dexmedetomidine have been found to be safe and effective sedation for magnetic resonance imaging ( MRI ). Our program experienced an increase in patients arousing and experiencing an adverse airway event during propofol sedation for MRI in the first months of using a new 3T (Tesla) MRI scanner that was found to have a longer reverberation time compared to the previous 1.5 T MRI . In an effort to decrease patient arousal and adverse airway events during MRI , we administered a dexmedetomidine load prior to our standard propofol protocol. The objective was to compare adverse events and other outcome measures of patients sedated with propofol alone (Pro) and propofol preceded by a dexmedetomidine load (D+P). Methods We reviewed a sedation database and medical records for all children undergoing 3T MRI studies while sedated with propofol alone or propofol preceded by a dexmedetomidine load in 2014. Results Two hundred and fifty‐six sedations were performed for MRI (87 Pro and 169 D+P). The two groups were comparable with regard to age, weight, gender, and American Society of Anesthesiologists status. Subjects in the D+P cohort had significantly fewer adverse events (10/169 patients (5.9%) vs 23/87 patients (26.4%) [ OR 0.18, 95% CI : 0.08–0.39, P   〈  0.001]), particularly upper airway obstruction. Mean discharge time was longer in the D+P cohort compared to the Pro cohort (87.1, SD 26.3 min vs 69.7, SD 23.6; [mean difference 17.7 min, 95% CI : 10.6–24.8, P   〈  0.001]). Conclusions The addition of a dexmedetomidine infusion prior to our propofol MRI sedation protocol resulted in fewer sedation‐related adverse events, particularly upper airway obstruction. Further studies are needed to evaluate the potential for a reduction on adverse events with this drug combination.
    Type of Medium: Online Resource
    ISSN: 1155-5645 , 1460-9592
    URL: Issue
    URL: Article
    DOI: 10.1111/pan.2017.27.issue-1
    DOI: 10.1111/pan.13041
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2008564-3
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  • 6
    Online Resource
    Online Resource
    Overt Glucocorticoid Excess Due to Inhaled Corticosteroid Therapy
    American Academy of Pediatrics (AAP) ; 1988
    In:  Pediatrics Vol. 81, No. 3 ( 1988-03-01), p. 452-455
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 81, No. 3 ( 1988-03-01), p. 452-455
    Abstract: Inhaled corticosteroids have become an important therapeutic option in the treatment of childhood asthma. The preparations currently available for pediatric use (beclomethasone dipropionate and triamcinolone acetonide) do not, in general, cause significant hypothalamic-pituitary-adrenal axis suppression and physical signs of glucocorticoid excess have not been described with their use. We report an 8-year-old girl with asthma in whom obesity, hirsutism, and growth retardation developed during treatment with inhaled triamcinolone acetonide alone. Laboratory studies showed suppression of endogenous cortisol production but did not demonstrate suppression of the hypothalamic-pituitary-adrenal axis. Cessation of inhaled triamcinolone acetonide therapy resulted in resolution of obesity and hirsutism, resumption of normal growth, and a return to normal of serum cortisol levels and urinary 17-hydroxycorticosteroid excretion. Careful monitoring of growth velocity and (if clinically indicated) morning serum cortisol levels in asthmatic children using inhaled corticorsteroids will detect the rare instance of glucocorticoid excess resulting from systemic absorption of these drugs.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.81.3.452
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1988
    detail.hit.zdb_id: 1477004-0
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  • 7
    Online Resource
    Online Resource
    Respiratory Depression in Young Prader Willi Syndrome Patients following Clonidine Provocation for Growth Hormone Secretion Testing
    Springer Science and Business Media LLC ; 2010
    In:  International Journal of Pediatric Endocrinology Vol. 2010 ( 2010), p. 1-8
    Details
    In: International Journal of Pediatric Endocrinology, Springer Science and Business Media LLC, Vol. 2010 ( 2010), p. 1-8
    Type of Medium: Online Resource
    ISSN: 1687-9848 , 1687-9856
    URL: Article
    DOI: 10.1155/2010/103742
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2010
    detail.hit.zdb_id: 2528691-2
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  • 8
    Online Resource
    Online Resource
    Kinesiology in 360 Degrees
    Informa UK Limited ; 2017
    In:  International Journal of Kinesiology in Higher Education Vol. 1, No. 1 ( 2017-01-02), p. 9-17
    Details
    In: International Journal of Kinesiology in Higher Education, Informa UK Limited, Vol. 1, No. 1 ( 2017-01-02), p. 9-17
    Type of Medium: Online Resource
    ISSN: 2471-1616 , 2471-1624
    URL: Article
    DOI: 10.1080/24711616.2016.1277671
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2017
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  • 9
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    Online Resource
    An exploratory study of distractions during the induction phase of pediatric procedural sedation with propofol
    Wiley ; 2023
    In:  Pediatric Anesthesia Vol. 33, No. 6 ( 2023-06), p. 466-473
    Details
    In: Pediatric Anesthesia, Wiley, Vol. 33, No. 6 ( 2023-06), p. 466-473
    Abstract: Distractions are a leading cause of disturbance to workflow during medical care. Distractions affecting the anesthetic team in the operating room are frequent and have a negative impact on patient care one‐fifth of the time. The objective of this study was to evaluate the frequency, source, target, and impact of distractions during the induction phase of pediatric procedural sedation outside the operating room. Methods Distractions were analyzed during propofol induction for oncology procedures from 45 video recordings. Distraction was defined as any event that disturbs or has potential to disturb the sedation team from performing their primary tasks. The type of distraction was cataloged into communication, coordination, extraneous events, equipment, layout, and usability. A five‐point Likert scale was used to quantify the impact on the sedation team or its members. Results All patients had a diagnosis of acute lymphocytic leukemia and had a mean age of 8.4 years. Five hundred and sixty‐seven distractions occurred and averaged 12.6 events (±5.6) per induction (mean induction time 3 min 12 s). Extraneous events were most common, accounting for 55% (312/567) of all distractions. Most distractions had an impact on the sedation team's workflow, resulting in multitasking (46%, n = 262), and in either brief or complete disruption from a primary task (17%). Sedation nurses were impacted most often, 62% of the time. Coordination and usability issues resulted in the greatest negative impact, mean ± SD, 3.7 ± 1.0 and 3.5 ± 0.9, respectively. There was no significant association between distractions and adverse events or induction length. Discussion Distractions are common during procedural sedation, with extraneous events being most frequent. Coordination issues within the team and usability problems had the greatest negative impact on sedation team workflow. Nurses were the most frequent target. Conclusion Distractions impacted sedation team workflow but had no association with patient outcomes.
    Type of Medium: Online Resource
    ISSN: 1155-5645 , 1460-9592
    URL: Issue
    URL: Article
    DOI: 10.1111/pan.v33.6
    DOI: 10.1111/pan.14649
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2008564-3
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  • 10
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    Online Resource
    The utility of the pretracheal stethoscope in detecting ventilatory abnormalities during propofol sedation in children
    Wiley ; 2019
    In:  Pediatric Anesthesia Vol. 29, No. 6 ( 2019-06), p. 604-610
    Details
    In: Pediatric Anesthesia, Wiley, Vol. 29, No. 6 ( 2019-06), p. 604-610
    Abstract: Monitoring of ventilation with capnography or a stethoscope is recommended because the detection of ventilatory abnormalities can be significantly delayed by the use of pulse oximetry alone in patients receiving supplemental oxygen. The aim of this study was to evaluate the diagnostic performance of the pretracheal stethoscope with pulse oximetry and capnography in detecting adverse respiratory events during propofol sedation in nonintubated children. We hypothesized that use of the pretracheal stethoscope would facilitate earlier detection of adverse respiratory events. Methods This was a prospective observational study of children undergoing procedural sedation at a pediatric sedation program. A pretracheal stethoscope, pulse oximetry, and nasal capnography were attached at the discretion of the sedation nurse and provider to monitor ventilation. Results We enrolled 104 patient encounters (mean recorded time, SD 8.3 ± 5.3 minutes) from February, 2015 to March, 2017. The pretracheal stethoscope was the first monitor to detect adverse events in 64% (25/39) of patients compared to 18% (7/39) for capnography and 15% (6/39) for pulse oximetry. Auscultation performed best at detecting upper airway obstruction but capnography and pulse oximetry performed best at detecting hypoventilation. The positive predictive value for detecting a true ventilation abnormality and 95% CI of the pretracheal stethoscope, pulse oximetry, and capnography was 100% (90%‐100%), 18% (10%‐31%), and 27% (18%‐38%), respectively. The negative predictive value and 95% CI of the pretracheal stethoscope, pulse oximetry, and capnography was 88% (82%‐92%), 68% (59%‐75%), and 70% (61%‐78%), respectively. Limitations are short observation time, nonstandardized application of respiratory monitors, and too much focus on auscultation. Conclusion A pretracheal stethoscope in conjunction with capnography and pulse oximetry detects most sedation‐related adverse events first. Auscultation performed best at detecting upper airway obstruction but capnography and pulse oximetry performed best at detecting hypoventilation.
    Type of Medium: Online Resource
    ISSN: 1155-5645 , 1460-9592
    URL: Issue
    URL: Article
    DOI: 10.1111/pan.2019.29.issue-6
    DOI: 10.1111/pan.13616
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2008564-3
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