Meeting Summary 1st Meeting of the Pediatric Sedation
Research Consortium – Hotel Sofitel – Chicago Il
May 17th, 2003
Introduction:
Dr. Cravero began the meeting by welcoming the participants and informing them of
the history of the formation of the Pediatric Sedation Research Consortium. Essentially
the origin of the group began with a multispecialty conference on pediatric sedation held
in Sept 2000 at Dartmouth Hitchcock Medical Center under a grant from AHRQ ( See
Dartmouth Pediatric Sedation Summit on http://an.hitchcock.org/pedisedation/). The
formation of this group is an outgrowth from that conference where it was felt that more
information sharing would be essential to any improvement in the provision of pediatric
sedation in the United States. More importantly we felt that the only way to bring the
practice of pediatric sedation forward at this point was to form a group that would allow
sharing of national/international data on the subject of pediatric sedation.
Subsequent to this introduction members of the consortium who were present introduced
themselves. They included:
Joseph Cravero MD
Associate Professor of Anesthesia and Pediatrics
Children’s Hospital at Dartmouth Hitchcock Medical Center
One Medical Center Drive
Lebanon, NH 03756
603-650-2908
Joseph.Cravero@Hitchcock.org
George Blike MD
George.Blike@Hitchcock.org
(all other info same as above)
Kristine Cieslak, MD
Senior attending physician
Cook County Children's Hospital
Department of Pediatric Emergency Medicine
Cook County Children's Hospital
Chicago,IL 60612
(312)633-5355 ED
(312) 760-0608 page
(312) 572-3717 fax
klcieslak@aol.com
John Berkenbosch, MD
Assistant Professor
Pediatric Intensivist (Pediatrics background) and Medical Director of our Pediatric
Procedural Sedation Service
Child Health, Pediatric Critical Care
University of Missouri-Columbia
One Hospital Dr.
Columbia, MO 65212
Phone: 573-882-6544
Fax: 573-882-2742
berkenboschj@health.missouri.edu
Kevin M. Creamer M.D.
LTC, MC
Medical Director of PICU and Pediatric sedation Unit
Walter Reed Army Medical Center
6900 Georgia Ave N.W.
Washington DC 20307
202-782-2826 Office
202-782-4326 Fax
Kevin.Creamer@NA.AMEDD.ARMY.MIL
Barry Gelman, M.D.
Associate Professor of Clinical Pediatrics
University of Miami School of Medicine
PO Box 016960 (R131)
Miami, FL 33101-6960
305-585-6051
Fax 305-325-0293
BGelman@med.miami.edu
James Hertzog, MD
Pediatric Intensivist
Department of Anesthesiology and Critical Care Medicine
Alfred I. duPont Hospital for Children
1600 Rockland Road
P.O. Box 269
Wilmington, DE 19899
(302) 651-5390
fax (302) 651-5365
jhertzog@nemours.org
Michelle Rhoads, MSN, CRNP
Sedation Advanced Practice Nurse
Day Medicine Unit
Alfred I. duPont Hospital for Children
1600 Rockland Road
P.O. Box 269
Wilmington, DE 19899
(302) 651-4530
fax (302) 651-4736
mrhoads@nemours.org
Rosemary Orr MD
Associate Professor of Anesthesiology and Pediatrics,
University of Washington
Attending Anesthesiologist and head of Sedation Services
Children's Hospital Regional Medical Center
Seattle, WA 98105
Tel 206 987 2123/987 2047
rosemary.orr@seattlechildrens
David M. Polaner, MD, FAAP
Attending Pediatric Anesthesiologist
The Children's Hospital
1056 East 19th Avenue, B090
Denver, CO 80218
Associate Professor of Anesthesiology
University of Colorado School of Medicine
voice: 303-861-6226
fax: 303-837-2899
polaner.david@tchden.org
david.polaner@uchsc.edu
Lynne G. Maxwell, MD
Department of Anesthesiology/Critical Care Medicine
Children's Hospital of Philadelphia
#9331 Main
34th St. and Civic Center Blvd.
Philadelphia, PA 19104
ph: 215.590.3842
fax: 215.590.1415
email: maxwell@email.chop.edu
Maxwell@email.chop.edu
Marc S. Leder,MD
Assistant Professor of Clinical Pediatrics
Attending Physician, Pediatric Emergency Medicine
Children's Hospital
700 Children's Drive
Columbus, Ohio 43205
Phone: (614) 722-4386
Fax: (614) 722-4380
lederm@pediatrics.ohio-state.edu
Jill A. Fitch MD
Critical Care Medicine
Columbus Children's Hospital
700 Children's Drive
Columbus Ohio 43205
Office 614-722-3441
Fax 614-722-3443
Fitchj@pediatrics.ohio-state.edu
Esther McClure, RN, MSN
Nurse Coordinator for Pediatric Sedation Team
University of Virginia
esther@nexet.net
Lia Lowrie, MD
Medical Director, Pediatric Intensive Care Unit
Rainbow Babies and Children's Hospital
Associate Professor of Pediatrics
Case Western Reserve University School of Medicine
Department of Pediatrics
Rainbow Babies and Children's Hospital
11100 Euclid Ave.
Cleveland, Ohio 44106-6010
Phone: 216-844-3310
Fax: 216-844-3310
lhl3@po.cwru.edu
Desmond Henry MD
Chairman, Department of Anesthesia
Director, Department of Surgical Services
The Children’s Hospital
henry.desmond@tchden.org
John C. Brancato, MD
Assistant Professor of Pediatrics and Emergency Medicine
University of Connecticut School of Medicine
Division of Emergency Medicine
Connecticut Children's Medical Center
Hartford, CT
(860) 545-9108
(860) 545-9202 fax
Dr. Arvind Kasaragod
Pediatric Critical Care Services
Avera McKennan Hospital
911 E. 20th St
Suite 102
Sioux Falls, SD 57105
Arvind.Kasaragod@mckennan.org
Phone: 605.322.3440
Discussion of Mission Statement and Organizing principles
(please see the mission statement and organizing principles on the website for the
consortium)
After informal introductions a focused conversation ensued concerning the organizing
principles of the group (available on the website as well). All present agreed to the
principles which emphasize the collaborative nature of the group and the “equal” nature
of all the partners. Dr Polaner pointed out the need to use the language “what is feasible
resources” rather that “economically practical” when referring to the idealized structures
for sedation care. Dr. Blike pointed out the fact that all businesses and organizations
need to deal with the fact that safety/protection must live in tension with “production” in
order to have a viable entity. The absolute best safety may require resources that make
adequate production for economic viability impossible. We proceed understanding that
pediatric sedation operates in this type of environment.
Dr. Cravero emphasized the need to cooperate in terms of publications and grant
funding. Since all participants are dependent on the entire group, all papers must include
all members as part of the authorship. In addition, all members of the group should be
made fully aware of grant request and an accounting of what is done with grant monies
must be made to the group each year.
In terms of quality improvement, Dr. Birchenbosch emphasized the need for adding
“anonymity” to paragraph concerning institutional involvement. Further discussion
involved the concept of “benchmarking” internally vs. externally. Comments were then
made by several individuals concerning the fact that this group may evolve into one that
advocates for better pediatric sedation care – including better reimbursement. Caution
was given that the group’s mission would be undermined if it became overly concerned
with improving reimbursement.
Difficulties involved in obtaining data on all patients in any one institution were
discussed. It was pointed out by Dr. Cravero that rather that push for 100% collection
from every site in a hospital (although ideal), we should push for 100% collection of data
from any sites that participate within a given hospital – (i.e. MRI, CT scan etc.) It is
hoped that this would avoid the problem of “selective” data reporting.
At this close of this discussion it was agreed that there should be a Chair of the
consortium and that there should be committees that served key functions such as
overseeing data requests and research proposals. It was agreed that each institution
should have ready access to their own information and that of the group as a whole. It
was thought to be important that the identity of which institution is sending specific data
– should be confidential to the rest of the group. It was also agreed that no one person in
the consortium should know the identity of the institutions submitting each data set. This
“key” that would link the data to an institution should rather reside with the data manager
at the Bioinformatics Group at Dartmouth. Requests for information and possible
identification of sites that have extremely favorable or unfavorable data would have to go
through a steering committee and obtain approval prior to being released. The steering
committee would have the charge of assuring protection of institutional identification,
assuring that requests were reasonable, and that there was no way to achieve the desired
improvement of practice without some release of data.
Dr. Cravero then presented a brief discussion of the HIPPA implications of the data
collection for the PSRC (please see HIPPA presentation on the website for the
consortium). He emphasized that the data as described thus far met the description of a
“limited data set” under the HIPPA regulations. As such there should be no specific
requirement to encrypt the information placed on the database for patient purposes. In
addition it may be possible to be exempt from consent requirements although an IRB
approval for the project should be sought at each institution. Dr. Cravero also mentioned
that in the near future it may be possible to have one institution (Dartmouth) approve the
protocol for data gathering and have that approval apply to all the institutions involved in
a project such as this. David Polaner pointed out the difficulty that investigators at his
institution had in obtaining consent for a data gathering proposal and indicated that
Denver may be a difficult institution to get a consent exemption.
Discussion of Sites and Sedation Issues
The second session of the day began with a general discussion of the different institutions
represented at the meeting and the nature of the pediatric sedation practice at those
institutions.
Dr. Cravero described an anesthesia-run sedation system at Dartmouth that performed
approximately 2000 procedural sedations per year. There are sedations performed by
pediatric cardiology and the emergency department that are not included in this number
but it was thought that this data could possibly collected on the web-based tool.
Dr. Maxwell then described the sedation situation at the Children’s Hospital of
Philadelphia. She believed that was at least 3000 sedations performed in a wide variety of
locations in the hospital with approximately 1000 sedations provided by the anesthesia
service which is called for specific patients and specific procedures. There is standard
documentation on a scanned data collection tool. QI tracks “unanticipated occurrences”.
Anesthesia records are automated and therefore are very different from the data collection
obtained by other providers. Barriers to participation include the size of the institution
and the huge number of providers involved in the very different areas that deliver
sedation.
Dr. Henry the described the situation at Denver Children’s Hospital. He heads a
multidisciplinary sedation committee that oversees 20 different sedation locations. There
is no specific sedation service provided by the hospital but there is common credentialing
and guidelines for sedation in all the areas. Difficult cases can be referred to
anesthesiology. Each of the different sedation locations reports quarterly on the number
of sedations provided in that venue. He estimated 4000-5000 sedations per year provided
at DCH. Current controversies involved that use of ketamine in the emergency
department, propofol use by non-anesthesiologists, and CO2 monitoring for all sedations.
Dr. Henry highlighted his questions as to how to benchmark sedation practice – local vs.
national data to be used?
Dr. Rosemary Orr reported on the experience at Children’s Hospital Seattle. A freestanding sedation unit is used for the sedation team. There is sedation committee which
reviews forms on occurrences. Sedation forms are completed by non-anesthesia
providers, while anesthesiologists complete an anesthesia record. There are 23 areas in
which sedation is done. The huge number of individuals involved in the sedation
workforce was seen as a barrier to completing the web-based form.
Kevin Creamer reported on the current status of Walter Reed Army Med Center. He
believed that 12-1300 cases were performed per year. The hospital has a sedation unit run
by intensivists. Anesthesiology is involved in failed sedations. A standard form is
completed by non-anesthesiologists and an OR record by anesthesia providers. He also
described a very well developed sedation training course which includes an on-line power
point presentation and PALS certification. The providers are rated by a “color” to reflect
their level of sedation training and can only participate in sedation at a level which is
approved for their color. Barriers to collecting data included the anesthesia providers who
so not use standard forms etc.
Columbus Children’s Hospital practice was described by Mark Leder and Jill Fitch. In
this institution moderate sedation is generally tried first followed by referral to the ICU
sedation service for failed cases. The emergency department takes care of a large number
of sedations using ketamine sedation with a very high success rate. QI efforts include a
checklist form that is completed on all sedations and a uniform audit form for pediatric
sedation. It was estimated that 3000 cases are performed in the radiology department
while 400 cases are performed by the ICU sedation team. Thousands of other cases occur
throughout the institution – notably in the very busy emergency department.
Cape Fear Hospital practice was described by Cindy Fletcher . It was estimated that
1500-2000 cases are performed per year. A nurse practitioner screens patients for
sedation and refers to anesthesia in the OR or peds intensivist/ED/PICU for others. Most
sedations are overseen by the nurse practitioner with one of these other providers as backup. There is a common sedation tool for recording data and all individuals are
credentialed for sedation by the same process.
The same general process for sedation was described for Sioux Falls.
University of Miami practice was described by Barry Gelman. Sedation there is practiced
in an ICU sedation unit. 600-700 cases per year are done in the unit with a total of 121500 cases done per year in the hospital as a whole. Patients are screened by an
intensivist. Extremely complex problems or patients are referred to the OR with
anesthesia but access to this system has historically bee a big problem.
Jim Hertzog discussed Alfred I. duPont Hospital for Children’s sedation practice. The
sedation practice there was reorganized in 1992. A PICU sedation service is available
and staffed by intensivists but sedation is practiced in many areas of the hospital. They
now perform approximately 2500 sedations per year. There is an online sedation training
module. A common tool is used for sedation data from all areas except the PICU and
anesthesia. The institution has a well-developed triage and screening process.
Flowsheets for sedation are extensive and there are over 14,000 that have been collected
over the last 10 years.
Esther McClure reported on the current pediatric sedation practice at UVA. There are
multiple possibilities for sedation including PO sedation by any one of a number of
providers in the institution, sedation by an ICU sedation group, or sedation by
anesthesiology. The sedation group performs approximately 800 cases per year while the
hospital in total performs as many as 1200 sedations per year. Sedation is provided at the
site where the procedure is usually done. Sedation reports are forwarded to the director of
anesthesia.
John Brancato was present to report on the situation at Connecticut Children’s Medical
Center. He estimated 1,500-1,800 sedations are provided by the sedation group there.
The sedation team is run out of the emergency department in an area adjacent to the
emergency department. Other sedation is provided by a multitude of providers. There is
standard data collection on a paper record. ASA class III or worse are referred to
anesthesia.
Lia Lowry appraised the gathering on the sedation practice at Rainbow Babies and
Childrens Hospital in Cleveland. The physical plant includes a free standing 200 bed
children’s hospital attached to a University Hospital. Credentialling for deep sedation is
very rigorous with providers taking a written course and completing 10 viewed cases on
patients where bag-mask ventilation and other airway management is required. An
advanced ICU-based sedation unit is in place. She reported that approximately 4000
sedations are accomplished per year and all are captured in a common database.
Scottish Rite Hospital (Atlanta) sedation practice was reported by David Fagin and
Steven Freilich. The sedation service is largely run by emergency medicine physicians
with 4-6000 cases done per year. Most sedations are started by EM physicians and
monitored by RN’s. Anesthesia is consulted on extremely difficult situations. There is a
common data collection tool used by sedation providers but not by anesthesiology.
Collection of anesthesia data was seen as a problem in going forward with web-based
data collection.
John Berkenbosch discussed University of Missouri’s pediatric sedation situation. They
exist as a children’s hospital within a hospital. The sedation service is run by intensivists
out of the PICU. About 1500 sedations per year are provided. A common data flow sheet
is used. He noted that sedation is sometimes provided by residents on surgical or other
services. Capture of this sedation data will present a major logistical problem.
Kristine Cieslak reviewed the sedation situation at Cook County Memorial Hospital. She
stated that there was no sedation team per se at her institution. Most sedations were
performed by either emergency medicine attendings or anesthesiology. There is
apparently a standard flowsheet for sedation, but the practice is very decentralized and
she thought that collecting data on a large percentage of sedations performed in the
institution would be quite difficult given the variety of individuals involved.
At the end of this session George Blike reviewed the sedation numbers put forth by the
various institutions involved (at this meeting) and estimated 40,000 sedations were taking
place and could possibly be captured. Although this may be optimistic for the
participating institutions, it was thought that when all the institutions that were not
present were considered, this number was not at all unlikely for a year of data collection.
Web Tool Development
The next session involved the development of the web-based data collection tool. The
discussions involved in this 4 hour long process are too detailed to completely review
here. I will present the tool that resulted from the discussion with notes in italics that
indicate key points that were made. Almost everyone present reported that they had used
the preliminary form of the tool and that it had worked will on their system. We then
proceeded with a question by question discussion of what should and should not be
included for outcome data. There was a lot of discussion on almost every question. It
was generally agreed that the tool should not take more than a few minutes to complete
for any one patient. In the end it was thought that we would come up with a
comprehensive tool and trial it extensively before deployment. Questions that were not
considered critical would be eliminated as needed to edit the data to that which was
possible to enter in the acceptable amount of time.
Q: Age (select appropriate age range, then enter number of months or years in
Age in months (0 - 35)
Age in years (3 - 18)
Q: Enter patient weight in kilograms.
(field for entry of number provided)
Q: What is the patient's gender?
Male
Female
Q: Select any coexisting medical problems.
text box).
(A very detailed discussion on the various entities to be included took place. As the list grew, it was decided
that we would break the list down into categories so that scrolling through would be quick and easy.
Essentially when done, only the bold categories would be seen initially – clicking on them would bring up a
pull down list of the entities below.)
None
Metabolic
 Failure to thrive
 Dehydration
 Renal failure
 Inborn error of metabolism
 Metabolic disorder
 Diabetes
 Obesity
Gastrointestinal
 GI bleed
 GERD
 Vomiting
 Cardiovascular
 Congenital heart disease cyanotic
 Congenital heart disease non-cyanotic
 arrhythmias
 Cardiac disease (other)
Heme/Onc
 Leukemia
 Mediastinal mass
 SS disease
 Brain Tumor
 Mediastinal Mass
 Hem/Onc (other)
Neurological
 CP
 Seizure disorder
 ADHD
 Neuromuscular disease - hypotonia
 Developmental delay
 Autism
Respiratory - Upper Airway
 Snoring
 Croup
 Cough
 Tracheostomy
 URI
 Stridor
Respiratory - Lower Airway
 Cystic fibrosis
 Pulmonary (other)
 Asthma history
 Wheezing
 Pleural disease
Prematurity Related
 Apnea
 BPD


Cardiorespiratory monitoring at home
Ex Premature infant (< 30 weeks and delivery and < 52 weeks post conceptual age at the time of the
procedure)
 Ex Premature infant (< 36 weeks at delivery and < 52 weeks post conceptual age at the time of the
procedure)
Craniofacial abnormalities
 Unusual facies
 Pierre Robin sequence
 Microagnathia
 s/p craniofacial surgery
S/P Trauma – in the last 24 hours or reason for current hospitalization
Liver disease
ASA status III-IV
s/p transplant
Immune compromise
Burn injury
Q: Specify other coexisting medical problems.
(text field provided)
Q: Select the procedure to be performed. (Once again this will consist of the bold fields and the
subcategories will only come up when the bold field is clicked)
Radiology
 Venogram/arteriogam
 PICC line placement
 MRI/MRA/MRV/MRS
 CT (diagnostic and interventional)
 Bone scan
 VCUG
 Ultrasound body
 Transthoracic echo
 Nuclear scan - Bone or Renal
 PET scan
Cardiology
 Cardiac cath (diagnostic)
 EP
 Interventional cardiac cath
 TEE
 Pericardiocentesis
 Cardioversion
Gastroenterology
 Colonoscopy
 Upper endoscopy
 Wound/burn care
 Bronchoscopy
 Liver biopsy
 Manometry
Hematology/Oncology
 Bone Marrow Aspiration/Biopsy
 Lumbar Puncture/intrathecal meds
 Radiation therapy
Bone and Joint/Skeletal
 Fracture Reduction
 Joint injections/aspiration
 Joint reduction
 Botox injection
Nerve/Brain/ear
 Brainstem Auditory Response Test
 EMG
 EEG
Surgical or Invasive Procedures
 Central line placement
 Central line removal
 Arterial line – peripheral
 Laceration Repair
 Burn dressing changes
 I & D of abscess
 Peritoneal dialysis catheter placement
 Renal biopsy
 Chest tube/thoracentesis
Ophthalmology exam
Dental examination/treatment
Foreign body removal (ear or nose)
Sexual abuse exam
Other
Q: Specify other procedure to be performed.
(text field provided)
Q: Select medication used.
Sedatives
 Propofol
 Midazolam
 Ketamine
 Pentobarbital
 Chloral hydrate
 Remifentanil
 Valium
 Etomidate
 thiopental
 Ativan
 Methohexital
 Dexmedetomidine
 DPT combination
Analgesics
 Fentanyl
 Morphine
 Meperidine
 Alfentanil
Local Anesthetics
 Lidocaine
 Bupivacaine
 EMLA cream
 Ionterphersis on lidocaine
Muscle Relaxants
 Nondepolarizing Muscle relaxants
 Succinylcholine
Inhaled Anesthetics
 N2O
 Sevoflurane
 Halothane
Sedative/Analgesic Reversal Agents
 Naloxone
 Flumazenil
Antiemetics
 Ondansetron
 Hydroxyzine
 Reglan
Anticholinergics
 Glycopyrrolate
 Atropine
Inhaled Meds
 Albuteral
 Racemic Epinephrine
Distraction Techniques
 Other
(these questions will only appear if you have clicked on the appropriate medication from the list above.
Total dose was the only number thought to be clinically relevant given all of the other confounders in this
data collection. Investigators who had tried to track this before reported that dose data added little to
sedation evaluation)
)
Q: Propofol total dose
 Bolus
 Infusion
Q: Choose route of medication delivery for Fentanyl.
 PO
 IV
 IM
 Intranasal
 Total dose
Q: Choose route of medication delivery for Midazolam.
 PO
 IV
 IM
 Intranasal
 Total dose
Q: Choose route of medication delivery for Ketamine.
 PO
 IV
 IM
 Total dose
Q: Pentobarbital total dose
Q: Choose route of medication delivery for Chloral hydrate.
 PO
 Rectal
 Total dose
Q: Inspired % of N2O
Q: Total dose for Remifentanyl.
Bolus
Infusion
Q: Choose route of medication delivery for Morphine.
 IV
 IM
 Total dose
Q: Total dose of Etomidate.
Q: Total dose of Pentathal
Q: Choose route of medication delivery for Ativan.
 PO
 IV
 IM
Total dose of Ativan
Q: Choose route of medication delivery for Glycopyrulate.
 IM
 IV
 Total dose
Q: Choose route of medication delivery for Lidocaine.
Sub Q
IV
Topical
Q: Rocuronium dose.
Q: Succinylcholine dose.
Q: Specify other medication used, and its route of administration.
(text field provided)
Q: Indicate type of monitoring used during the procedure.
 SPO2
 ECG
 BP
 ETCO2
 BIS
 Pleth
 Precordial steth
 Other

None
Q: Specify other type of monitoring used during the procedure.
(text field provided)
Q: Select type of provider responsible for the sedation.
 CRNA
 APRN/PNP
 Anesthesiologist/intensivist
 Intensivist- Pediatrician
 Pediatrician - subspecialist
 Emergency Medicine Physician
 Pediatric Emergency Medicine Physician
 Anesthesiologist
 Pediatric Anesthesiologist
 Radiologist
 Pediatric Radiologist
 Dentist
 Pediatric Dentist
 Oral Surgeon
 House staff
 PA/Anesthesia Assistant
Q: Select type of provider actually delivering the medication:
 Medical Technologist – or equivalent training
 RN
 CRNA
 APRN/PNP
 Anesthesiologist/intensivist
 Intensivist- Pediatrician
 Pediatrician - subspecialist
 Emergency Medicine Physician
 Pediatric Emergency Medicine Physician
 Anesthesiologist
 Pediatric Anesthesiologist
 Radiologist
 Pediatric Radiologist
 Dentist
 Pediatric Dentist
 Oral Surgeon
 House staff
 PA/Anesthesia Assistant
Q: Select type of providers monitoring the patient (present for monitoring during the case.
 Medical Technologist – or equivalent training
 RN
 CRNA
 APRN/PNP
 Anesthesiologist/intensivist
 Intensivist- Pediatrician
 Pediatrician - subspecialist
 Emergency Medicine Physician










Pediatric Emergency Medicine Physician
Anesthesiologist
Pediatric Anesthesiologist
Radiologist
Pediatric Radiologist
Dentist
Pediatric Dentist
Oral Surgeon
House staff
PA/Anesthesia Assistant
Q: Was the sedation supervisor also performing the procedure?
Q: How would you describe the conditions produced with regard to procedure



completion?
Unsuccessful - could not perform procedure
Procedure performed - conditions not ideal
Ideal conditions - patient calm and still during procedure
Q: Sedation start time (giving the drug)
(field for entry of number provided)
Q: Procedure end time –
(field for entry of number provided)
Q: Discharge time (return to previous care location) – (field entry for number provided.
Q: Indicate any side effect or complication that occurred.
None
Respiratory
 Apnea > 15 seconds
 Unplanned intubation or
 positive pressure ventilation
 Desaturation: O2 Sat (below baseline) for greater than 60 seconds
 Vomiting
 Aspiration
Need for reversal
 Use of reversal agent for opiates
 Use of reversal agent for benzodiazepines
Airway
 Emergency airway consultation required
 laryngospasm
 Delirium/agitation
Cardiac Related
 Cardiac Arrest
 Blood Pressure < 50% baseline


Heartrate < 50% baseline
Dysrhythmia
Neuro
 Seizure
 Death related to sedation
 Prolonged recovery time
Unintended deeper level of sedation
Unplanned admission to hospital or increase in level of care due to sedation
Other
Q: (if desat is clicked) What was the lowest level of O2 saturation.
 < 90%
 < 80%
 < 70%
Q: Specify other side effect or complication that occurred.
Q: When did complication occur?
Preprocedure/intraprocedure/transport/recovery/remote to procedure
Q: Was the procedure aborted because of problems with sedation? Yes/No
Q: What was the NPO status (in hours) at the time of sedation with respect to
 <2
 2
 4
 6
 >= 8
clear liquids?
Q: What was the NPO status (in hours) at the time of sedation with respect to
liquids?\
 <2
 2
 4
 6
 >= 8
solids and non-clear
Q: Airway management required during the case?







O2 mask or nasal cannula only
Repositioning
Oral airway
NP airway
Jaw thrust
LMA
ET tube
Q: Location of sedation:


Sedation Unit
Peds floor







ED
Critical Care
Peds/specialty clinic
OR
Radiology
Cath lab
Other
Transport during sedation?
Yes/no
Finances:
Dr. Cravero reviewed the current status of the financial underpinnings of the
consortium. To date the group has been supported by the Department of Anesthesiology
at Dartmouth Hitchcock Medical Center. Money has been spent to create the sample
web-based data collection tool ($2500) and the incidental expenses for this meeting
($1500). Ongoing expenses for the group will include further development and
deployment of the data collection tool. In addition there will be costs associated with
maintenance of the data and generation of reports. The estimated cost to fully fund the
consortium for the first year would be about $10,000. It is possible that work could
continue on development of the web-based data collection tool for less money, but
deployment and data maintenance with full functionality would be somewhere in this
neighborhood. Dr. Cravero emphasized the point that grant funding for the project
should be forthcoming and that future function of the consortium should be made
possible with some type of funding mechanism.
It was emphasized that grant funding would not be available until Jan 2004 at the
earliest and other forms of seed money should be sought to “keep the ball rolling” until
some other income can be found. Dr. Cravero suggested that each institution
participating in the consortium could be asked to donate $500-1000 for the first year. In
the scope of most hospital budgets this would represent a modest contribution and in
return each institution would receive the use of the web-based sedation tool and access to
comparative information on sedation activity within the group. Several members of the
group agreed that this should be possible from their institution – if the “pitch” was made
correctly.
NPSF Grant:
As part of this discussion, Dr. Cravero and Blike presented a letter of intent that was
written to the National Patient Safety Foundation (NPSF). The letter has been made
available on the web. This letter asked for two years of funding for a total of $100,000
for data management expertise and for organizational time (Cravero). The goal as stated
in the letter is to collect information on the practice of pediatric sedation across several
specialties and in a wide geographic distribution with the goal of identifying best
practice. Future years would be spent on modeling excellent practice and deploying
changes in some of the member institutions while others retain their current practice.
Once again it was emphasized that full disclosure of grants made in the name of the
consortium should be made and a full accounting of the grant money should be made to
the group each year after a grant has been awarded.
Affiliations:
Dr. Cravero explained that he had discussed (with the AAP Section on Anesthesiology
and Pain Management – specifically Dr. Polaner) the idea of working with their
committee on quality assurance to obtain their endorsement for the PSRC. There were
few comments from the group on this subject. It was generally agreed that this type of
endorsement would be helpful but only so long as it came with no “strings” attached.
Specifically it was felt that we do not want a particular group forcing us in any direction
we do not want to go – or pushing a specific agenda.
Conclusion:
. Several members present brought up the possible difficulty of numbering the patients as
they were entered into the data base. It was concluded that each site within a given
institution would have a unique identifier and a system would have to be put in place to
be sure that the next sequential number was used for each patient entered at each site.
This was recognized as a significant problem that will likely take some time and effort by
the PI at each institution to solve for themselves. It was agreed that information will need
to be shared each step of the way as solutions to these logistical problems are pioneered.
Future Meeting:
Dr. Cravero suggested the idea that a multispecialty meeting on pediatric sedation by
entertained as the site for the next PSRC meeting. Denver and Columbus Ohio were
mentioned as possible meeting venues for the first annual meeting of the PSRC in
combination with a pediatric sedation meeting. The ideal would be to have a one or two
day meeting on sedation with speakers from various specialties on different aspects of
pediatric sedation (credentialing etc.) The meeting would then provide a forum for a one
day meeting of the PSRC for participating members. This suggestion was greeted with
general approval as many thought such a meeting would be helpful and widely attended.
Many suggestions were made as to how to publicize the meeting on various list-serves
etc.
Structure of PSRC
At the end of this process there was a brief discussion of issues to be decided for the
“structure” of the PSRC. Esther McClure then suggested that we should name
individuals to the positions in the structure of the PSRC. At this Joe Cravero offered to
serve as the chairman of the group for a two year term. George Blike will serve as Cochair and assistant for the group during that time. Dr. Cravero reiterated his concern that
the leadership of the group be shared between individual of different specialties and that
no one person dominate the group for any significant period of time. Committee
appointment were made (fairly informally) and it was agreed that other members could
easily be added and the make-up of the committees could change with time.
The Data Management Steering Committee was appointed:
Lia Lowrie
Lynne Maxwell
John Berckenbosch
Mark Leader
Esther McClure
Annual Meeting Committee:
David Polaner
Jill Fitch
Kevin Cream
Jim Hertzog was asked to head up the research oversight committee.
All in attendance agreed that it was too late to tackle any other issues at that point and the
group adjourned for dinner at the Rosebud Restaurant in Chicago.
JPC