Depth of consciousness and deep sedation attained in children as administered by nonanaesthesiologists in a children's hospital.
BACKGROUND
Sedation of children is administered by nonanaesthesiologists in a variety of locations within our children's hospital. The purpose of this study was to assess the depth of sedation administered to children in four locations using the Bispectral Index (BIS) and the University of Michigan Sedation Scale (UMSS).


METHODS
Eighty-six children under the age of 12 years undergoing procedures with conscious or deep sedation were enrolled. The study included patients undergoing cardiac catheterization, computerized tomography imaging, gastrointestinal endoscopy, and dental procedures. Sedation for each procedure was based on departmental protocols and preferences; the study did not dictate choice or dose of drugs. An independent observer applied the UMSS sedation scale at 10 min intervals for 1 h. The observer and the personnel administering sedation were blinded to the BIS score, which was recorded continuously.


RESULTS
The goal of either conscious or deep sedation was attained in 53% (BIS) and 72% (UMSS) of patients. Depth consistent with general anaesthesia was observed in 35% (BIS) and 0% (UMSS), and an awake state was observed in 12% (BIS) and 28% (UMSS). About 8% of patients experienced desaturation and airway events associated with deeper levels of sedation.


CONCLUSIONS
Our data demonstrate wide variations in depth of sedation attained in the hospital. The goal of either conscious or deep sedation was not achieved in a significant number of children. This is a therapeutic failure that requires reassessment of sedation protocols and investigation of new approaches.
Department of Anesthesiology, The Children's Hospital and University of Colorado School of Medicine, Denver, CO 80218, USA.
Dominika
D
Motas
Nicole Brown
NB
McDermott
Tamitha
T
VanSickle
Robert H
RH
Friesen
D000768:Anesthesia, General; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000145:classification; D003243:Consciousness / Q000145:classification; D003729:Dental Care; D004569:Electroencephalography; D016099:Endoscopy, Gastrointestinal; D006776:Hospitals, Pediatric; D006801:Humans; D008505:Medical Staff, Hospital; D014057:Tomography, X-Ray Computed; D014851:Wakefulness