Sedating affect

With this practice increasing, the debate about safety and the practitioner core competency requirements to provide sedation and/or analgesia to the complex pediatric patient with developmental disabilities and neurologic disorders has also increased and several policy statements have been published by different professional societies [2], with no clear evidence of practice standards and incidence of adverse outcomes.To aid in the investigation of the practice and potential adverse outcomes associated with the delivery of sedation outside the operating room, the Pediatric Sedation Research Consortium (PSRC), a collection of 37 institutions that share information on sedation practices within their individual institutions, has created a self-reporting prospective, observational database.The purpose of this paper is to provide the pediatrician and pediatric subspecialist a better understanding on the neurologic effects of different sedative and analgesic medications so that rational and safe choices can be used in children with developmental disabilities and neurologic disorders without causing further “neurologic” compromise.We performed an extensive review of the medical literature regarding sedation analgesia in children with developmental disability and neurologic disorders utilizing Pubmed.Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA 19129, USAReceived 2 December 2009; Revised 15 June 2010; Accepted 20 June 2010Academic Editor: Savithiri Ratnapalan Copyright © 2010 Todd J. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Sedation and analgesia performed by the pediatrician and pediatric subspecialists are becoming increasingly common for diagnostic and therapeutic purposes in children with developmental disabilities and neurologic disorders (autism, epilepsy, stroke, obstructive hydrocephalus, traumatic brain injury, intracranial hemorrhage, and hypoxic-ischemic encephalopathy).Developmental disability is defined by these investigators as delay in one of the following: fine/gross motor, cognitive, speech/language, social/personal, and activities of daily living.

So what are the actual added risks associated with sedation of the pediatric patient with developmental disabilities or neurologic disorders?However, despite zero deaths in the 49,836 sedation encounters, one in 65 of these sedation encounters was associated with stridor, wheezing, airway obstruction, laryngospasm, or central apnea, conditions that all have the potential to deteriorate to respiratory failure and death.Airway obstruction and pulmonary complications were the most frequently cited adverse event.In addition to a baseline risk for airway compromise in patients with developmental disability, Cortellazzi and colleagues showed that the risk for airway obstruction significantly increased in neurologically impaired children undergoing MRI who were administered a combination of sedative medications [10].Thus, as practitioners escalate pharmacologic intervention a patient with developmental disabilities or neurologic disorders is at increased risk for airway obstruction and may need higher level of care, including the potential need for a pediatric emergency medicine specialist, anesthesiologist, or intensivist.

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