Article on Conscious Sedation in Children

[Guest guest]

Thought you all might be interested -- I know the Fentanyl/Versed combo

is the most commonly used one, at least for me, so I thought I'd pass

the word to you all. They are recommending using propofol instead. Just

something to ask the doc about, if you are concerned (ONE more question

for the doc!!).

Take care,

http://pediatrics.medscape.com/reuters/prof/1999/10/10.25/cl10259g.html

Remifentanil Plus Midazolam Not Recommended For Conscious

Sedation in Children

WESTPORT, Oct 25 (Reuters Health) - Remifentanil, when used in

combination with midazolam for sedation and

analgesia in children undergoing brief painful procedures, causes " ...a

high incidence of life-threatening respiratory

depression at subtherapeutic levels. "

Dr. S. Litman of the University of Rochester School of Medicine

and Dentistry in Rochester, New York,

administered midazolam followed by remifentanil to 17 children, aged 2

to 12 years scheduled to undergo brief procedures

including " ...bone marrow biopsy, renal biopsy and closed fracture reduction. "

Although remifentanil successfully sedated the children in 17 out of 20

procedures performed, four children developed

hypoxemia and 10 developed apnea. Verbal prompting corrected both

conditions in all patients but on, a 2-year-old who did

not respond to verbal instructions.

Dr. Litman writes that " ...the combination of midazolam and remifentanil

was not a useful conscious sedation

technique...due to a high incidence of respiratory depression at

subtherapeutic doses and frequent need for additional

sedatives to provide patient comfort. "

He adds that his institution has " ...since discontinued the use of the

remifentanil and midazolam combination...and all

subsequent patients receive a propofol-based technique. "

In an interview with Reuters Health, Dr. Litman noted that

" ...remifentanil is more dangerous than propofol. " He added

that even though propofol induces unconsciousness, it has a safe history

and a " ...therapeutic ratio that is wider than most

other sedatives. " An anesthesiologist should be present when using

propofol, according to the Rochester clinician, or there

could be liability issues.

Dr. Litman writes in the article that remifentanil " ...is generally

contraindicated in children younger than 4 or 5 years, or in

older children with cognitive impairment, " and he advises that

" ...patients be selected based on their ability to comprehend

that they will be frequently prompted to breathe throughout the

procedure. "

He further recommends that " ...practitioners who administer this

combination of sedatives should expect respiratory

depression, be alert to its onset, and be skilled in airway maintenance

techniques. "

Arch Pediatr Adolesc Med 1999;153:1085-1088.

[Guest guest]

In a message dated 10/31/99 4:06:45 AM Eastern Standard Time,

williamk@... writes:

<< Thought you all might be interested -- I know the Fentanyl/Versed combo

is the most commonly used one, at least for me, so I thought I'd pass

the word to you all. >>

, thanks for the article! had the Fentanyl/Versed combo during

his three procedures this year (endoscopy, liver biopsy, colonoscopy), and he

required O2 support all three times. I'll pass the article on to his doctors.

Thanks again!

Debbie, Mom to , 3.5 yrs old, Severe Combined Immunodeficiency post Bone

Marrow Transplant, IVIG Dependant, gastrostomy tube fed, gastroesophageal

reflux disease (GERD) with hiatal hernia, Inflammatory Bowel Disease (IBD),

epilepsy, hypotonic cerebral palsy, developmental delays, cortical vision

impairment, non-verbal, who happens to look like a very young Rob Lowe

[Guest guest]

Thanks for the info ,

We have always used Chloral Hydrate and have had great results. is

never groggy after.

;o)

Article on Conscious Sedation in Children

>

>

>Thought you all might be interested -- I know the Fentanyl/Versed combo

>is the most commonly used one, at least for me, so I thought I'd pass

>the word to you all. They are recommending using propofol instead. Just

>something to ask the doc about, if you are concerned (ONE more question

>for the doc!!).

>Take care,

>

>

>http://pediatrics.medscape.com/reuters/prof/1999/10/10.25/cl10259g.html

>Remifentanil Plus Midazolam Not Recommended For Conscious

>Sedation in Children

>

>

>WESTPORT, Oct 25 (Reuters Health) - Remifentanil, when used in

>combination with midazolam for sedation and

>analgesia in children undergoing brief painful procedures, causes " ...a

>high incidence of life-threatening respiratory

>depression at subtherapeutic levels. "

>

>Dr. S. Litman of the University of Rochester School of Medicine

>and Dentistry in Rochester, New York,

>administered midazolam followed by remifentanil to 17 children, aged 2

>to 12 years scheduled to undergo brief procedures

>including " ...bone marrow biopsy, renal biopsy and closed fracture

reduction. "

>

>Although remifentanil successfully sedated the children in 17 out of 20

>procedures performed, four children developed

>hypoxemia and 10 developed apnea. Verbal prompting corrected both

>conditions in all patients but on, a 2-year-old who did

>not respond to verbal instructions.

>

>Dr. Litman writes that " ...the combination of midazolam and remifentanil

>was not a useful conscious sedation

>technique...due to a high incidence of respiratory depression at

>subtherapeutic doses and frequent need for additional

>sedatives to provide patient comfort. "

>

>He adds that his institution has " ...since discontinued the use of the

>remifentanil and midazolam combination...and all

>subsequent patients receive a propofol-based technique. "

>

>In an interview with Reuters Health, Dr. Litman noted that

> " ...remifentanil is more dangerous than propofol. " He added

>that even though propofol induces unconsciousness, it has a safe history

>and a " ...therapeutic ratio that is wider than most

>other sedatives. " An anesthesiologist should be present when using

>propofol, according to the Rochester clinician, or there

>could be liability issues.

>

>Dr. Litman writes in the article that remifentanil " ...is generally

>contraindicated in children younger than 4 or 5 years, or in

>older children with cognitive impairment, " and he advises that

> " ...patients be selected based on their ability to comprehend

>that they will be frequently prompted to breathe throughout the

>procedure. "

>

>He further recommends that " ...practitioners who administer this

>combination of sedatives should expect respiratory

>depression, be alert to its onset, and be skilled in airway maintenance

>techniques. "

>

>Arch Pediatr Adolesc Med 1999;153:1085-1088.

>

>>This forum is open to parents and caregivers of children diagnosed with a

Primary Immune Deficiency. Opinions or medical advice stated here are the

sole responsibility of the poster and should not be taken as professional

advice.