Correspondence
No Advantage
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In these times of staff shortages we do not really see any advantage in having a team administering analgesia and sedation.
As per the guidelines, a doctor is not allowed to perform surgery while simultaneously administering the sedation. The presence of a second physician is therefore necessary for medicolegal reasons.
So far, no curriculum exists for the training of analgesia-sedation teams. The sedation guidelines stipulate the need for specialized sedation training for doctors and non-medical assisting staff in the context of quality assurance (1). At the same time, specialized training regulations for premedication and emergency management exists only in individual settings.
If this applies to the sedation of adults, how much more difficult will it be to introduce similar training for the sedation of children? And where would such training take place outside the settings of pediatric anesthesiology or pediatric intensive care medicine? These specialties are already beset by bottlenecks in training. Also, a certain number of cases per year would have to be guaranteed for the purposes of quality assurance.
To provide emergency management without problems, an experienced doctor has to be available within the shortest possible amount of time, especially for very small children. Resuscitation teams, however, are often not sufficiently trained to deal with children.
The selection of drugs seems difficult. Especially the choice of analgesics seems arbitrary. Fentanyl has a pronounced respiratory depressant effect and is therefore not the first choice for sedation (2).
Instead of introducing a new qualification, it would be sufficient for analgesia-sedation to be administered outside intensive care wards only by specialists in anesthesiology and pediatricians with further qualifications in intensive care medicine or neonatology, whose everyday clinical practice includes airway management and handling medical drugs that have a depressant effect on the central nervous system.
DOI: 10.3238/arztebl.2010.0784b
Prof. Dr. med. Claudia Spies, Dr. med. Maren Schmidt, Dr. med. Irit Nachtigall,
Klinik für Anästhesiologie m. S. Intensivmedizin der Charité
Prof. Dr. med. Christoph Bührer,
Klinik für Neonatologie der Charité
Prof. Dr. med. Heiko Krude, Dr. med. Stephan Henning, Dr. med. Hannelore Ringe,
Klinik für Allgemeine Pädiatrie und Pädiatrische Intensivmedizin der Charité
On behalf of the authors:
Prof. Dr med. Claudia Spies
Charité – Universitätsmedizin Berlin
Klinik für Anästhesiologie m. S. Intensivmedizin CCM/CVK
Augustenburger Platz 1
13353 Berlin, Germany
Claudia.Teipelke@charite.de
