Analgosedation for diagnostic and interventional procedures: a countrywide survey of pediatric centers in Germany

Abstract

Background: As more and more diagnostic and interventional options are becoming available for use in pediatric patients, techniques of procedural sedation analgesia (PSA) are being administered in considerably growing numbers as well. Aims: The objective of this research effort was to conduct the first countrywide survey on the status quo of sedation analgesia as delivered to children and adolescents in Germany. Methods:We dispatched letters to all pediatric hospital settings in Germany (n = 305), including a questionnaire that had been developed with existing guidelines taken into account. Its items were designed to elucidate the current practice of PSA throughout these pediatric centers regarding (a) organizational structures and (b) standards of medication and staffing. Results: A total of 138 centers returned the questionnaire, hence the response rate was 45.2%. Numerous centers had implemented adequate structures and staffing standards. Deficits were nevertheless identified, most notably in terms of on-location equipment and staff provided to deliver sedations. Essential items of equipment were not provided in up to 26.8% of centers. Adequate staffing was not provided in up to 44.2% of centers, depending on the diagnostic or interventional procedures for which the PSA was delivered. The most widely used sedative agents were midazolam, ketamine/esketamine, and propofol. Conclusions: Adequate care structures for the management of procedural sedation analgesia have been implemented by many pediatric centers in Germany. On the downside, these findings also reveal deficits that will take efforts to be eliminated.

National survey revealed variable practices in paediatric procedural sedation and patient monitoring

“…Midazolam was the most popular sedative in our survey, and as per published reports, it appears to be in widespread use for paediatric sedation around Europe 15,20 . Propofol and thiopental were more commonly prescribed by anaesthesiologists, reflecting the current recommendations of the European Society of Anaesthesiology 8 .…”

“…However, we managed to ensure nationwide coverage of responses and received responses from university hospitals and central hospitals, as well as from the private sector, so we believe our results reliably present the current national practices in Finland. Additionally, the number of respondents is comparable to that of previously published surveys assessing paediatric procedural sedation 15,20 . Second , the number of anaesthesiologists and paediatric surgeons responding to the survey was significantly lower than the number of paediatricians.…”

“…This nationwide survey revealed that although sedative premedication is commonly used, only 23% of the physicians prescribing sedation for minor procedures off‐site have been trained to manage potential sedation‐related adverse events. Although almost as low numbers have previously been reported by Sauer et al, 15 this raises concerns on patient safety. Regular training and national guidelines could improve the safety of procedural sedation and might reduce the high variation in pre‐anaesthetic evaluation, monitoring and follow‐up 16 …”

Sensory nerve conduction studies in infants, children and teenagers – An update

“…In case of an urgent indication for a NCS diagnostic, analgosedation can be considered ( Ryan et al, 2019 , Spires et al, 2017 ). Propofol and midazolam are among the most used sedativa for a paediatric population ( Alletag et al, 2012 , Krauss et al, 2014 , Sauer et al, 2016 , Sauer et al, 2020 ). However, these substances may influence sensory NCS parameters.…”