title: A proposed mechanism to assess knowledge of pediatric hospitalists to identify and manage rare events during procedural sedation.
abstract: OBJECTIVE
  The goal of this study was to assess the knowledge of pediatric hospitalists (PHs) in identifying and managing rare events during procedural sedation (PS) with ketamine and nitrous oxide (N2O).
  
  
  METHODS
  A Web-based survey with multiple choice questions and case scenarios was used to determine the knowledge of PHs in identifying infrequent contraindications and managing laryngospasm, a rare life-threatening complication during PS. The survey was sent to all PHs at St Louis Children's Hospital.
  
  
  RESULTS
  Forty percent of experienced PHs (>50 sedation procedures performed) and 5% of inexperienced PHs (<50 sedation procedures performed) identified all 4 ketamine contraindications. Twenty-one percent of experienced PHs and 4% of inexperienced PHs identified all 6 N2O contraindications. Ninety-five percent of PHs identified presence of laryngospasm in a case scenario. As the patient in the case scenario progressed from partial to complete laryngospasm, 84% and 82% of PHs chose either the preferred or acceptable strategy to manage the patient. With further deterioration in the patient's status in the scenario, 66% and 71% of PHs chose either the preferred or acceptable strategy to manage the patient. The preferred strategy at each step is one that attempted the least invasive maneuver to manage the patient. There was no significant difference between experienced and inexperienced PHs in the management of laryngospasm.
  
  
  CONCLUSIONS
  Knowledge gaps exist among PHs regarding contraindications for ketamine and N2O that are infrequently encountered in patients and for the management of laryngospasm, a rare adverse event with ketamine. Ongoing teaching tools are necessary to assess and maintain the knowledge of sedation providers regarding rare events during PS that can improve their proficiency.
authors.affiliation: Department of Pediatrics, Washington University School of Medicine/St Louis Children's Hospital, St Louis, Missouri.
authors.forename: Mythili
authors.initials: M
authors.lastname: Srinivasan
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Carlson
keywords: ketamine; laryngospasm; nitrous oxide; pediatric hospitalists; procedural sedation