Improving outcomes in pediatric procedural sedation

Abstract

Background: In Fall 2003, Chris Evert Children's Hospital (CECH; Fort Lauderdale, Florida) exclusively used chloral hydrate for moderate sedation. As procedures became longer and more complex, pentobarbital became the primary sedative used. Yet children receiving pentobarbital were awakening during the procedure from paradoxical drug reactions or insufficient sedation. In 2003, the failed sedation rate was 12.29%--more than six times the national benchmark of 2%.

Methods: The pediatric sedation team created a pediatric sedation protocol, which reflected the designation of an a2-adrenergic agonist, dexmedetomidine (dex), as the drug of choice and spearheaded a variety of performance improvement changes, including creation of a stand-alone eight-bed sedation unit to accommodate the registration process and pre-assessment and postprocedure monitoring and to include the parent in the treatment continuum.

Results: Following the implementation of the new protocol in 2003, the failed sedation rate for children undergoing various diagnostic and therapeutic procedures decreased from 12.29% to 1.63% in 2004, 0.19% in 2005, and 0.28% in 2006; in 2007 the rate was 0.72%--reflecting an average 98% reduction in the failed sedation rate.

Discussion: The continued improvement and success in pediatric sedation over time indicates that the protocol has sustained benefits and lasting value.