Validation of the Ramsay scale for invasive procedures under deep sedation in pediatrics

Abstract

Background:The Ramsay scale is the most widely used scale during pediatric procedures although it has not been formally validated.Objective: To validate the Ramsay scale during invasive procedures under sedation in pediatrics.Methods: A prospective analytic study was conducted in two hospitals. All patients ≥6 months that were undergoing invasive procedures under sedation were enrolled.All were recorded, and these videos were edited and randomized. 150 videos were scored by four observers (a pediatrician, a pediatric intensive care unit nurse, an anesthetist, and an operating room nurse). All videos were scored with the Ramsay scale and University of Michigan Sedation Scale. Observers were blinded to drug administration. Construct validity was measured through Wilcoxon test paired samples after administration of sedatives. Criterion validity, intra-observer reliability, and interobserver correlation were evaluated by comparing the scores of the scales using Spearman's correlation coefficient. Interobserver agreement was measured using the intraclass correlation coefficient. To assess test-retest reliability, 50 videos were randomly selected and reevaluated.Results: Sixty-five patients were included. Construct validity was demonstrated through changes in the Ramsay scale scoring after administration of sedatives (p < .0001). Regarding criterion validity, the Ramsay scale had a high correlation with the UMSS (ρ = 0.621). Intra-observer agreement was ρ = 0.884. The Ramsay scale showed interobserver reliability with an intraclass correlation coefficient = 0.94 when comparing it with the University of Michigan Sedation Scale. Internal consistency was α = 0.91. Regarding applicability, in our study, it was applied in two hospitals in different areas by four professionals from distinct categories. Conclusions:The Ramsay scale is valid, reliable, and applicable to monitoring sedation for invasive procedures under deep sedation in pediatrics.

Effect of ketorolac tromethamine combined with dezocine prior administration on hemodynamics and postoperative analgesia in patients undergoing laparoscopic hernia repair

“…[ 26 ] The dynamic changes of intraoperative blood pressure and heart rate can directly reflect the changes in the hemodynamics of patients, especially at a specific time point of operation. VAS score [ 27 ] and Ramsay sedation score [ 28 ] are widely used to evaluate perioperative analgesia and sedation levels of patients. Therefore, in this study, preoperative intravenous administration of ketorolac tromethamine and dezocine was selected to reduce surgical stress and reduce the occurrence of hyperalgesia after remifentanil, improve the quality of patients’ recovery and reduce the occurrence of agitation and hemodynamic disorders during patients’ recovery, and the above observation indicators were selected.…”

The relationship between different bispectral index and the occurrence of dreams in elective surgery under general anesthesia: protocol for a randomized controlled clinical trial

“…Each score consists of 7 questions, ranging from 0 to 3 (each score is 0-21), depending on the probability of the psychological problem described. Patients with a score of 11 or higher can be classified as possibly significant [13,14]. We evaluated HADS score of patients the day before surgery.…”

Effect of Dexmedetomidine on Recovery from Anesthesia in Gynecologic Laparoscopic Surgery

“…The Ramsay sedation scores were recorded in both groups immediately after drug discontinuation, 10 min after drug discontinuation, 30 min after drug discontinuation and 60 min after drug discontinuation. The Ramsay sedation score was 6 points in total, with <2 points for poor sedation, 2-4 points for ideal sedation and 5-6 points for excessive sedation [7] .…”