LNSLNS

It is regrettable that the opportunity for an interdisciplinary statement in coordination with the German Society of Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI), the Professional Association of German Anaesthesiologists (Berufsverband Deutscher Anästhesisten, BDA), and the German Society of Pediatrics and Adolescent Medicine (Deutsche Gesellschaft für Kinder- und Jugendmedizin, DGKJ) was not used, and we wish to contradict the authors’ statement that specially trained non-anesthesiologists (analgesia-sedation team) will ensure a standard of patient safety in patients of ASA classes I and II during the administration of analgesia-sedation that is comparable to that provided by anesthesiologists (even when propofol is used).

To write that problems are unlikely to occur in children of ASA classes I and II is to play down reality and risk danger. No compromise is possible with regard to the qualifications of the sedation team: every child requires a fully trained and experienced anesthesiologist.

Deep analgesia-sedation is a variant of general anesthesia, and unexpected incidents with life-threatening consequences may occur at any stage, even in completely healthy children. The boundaries between the stages of sedation are fluid, and moderate sedation can turn into deep sedation at any stage. For this reason, the German Society of Anaesthesiology and Intensive Care Medicine and the Professional Association of German Anaesthesiologists have unequivocally explained in a recent statement:

“Planned deep analgesia-sedation or analgesia-sedation in patients at risk (which includes children) should be administered by anesthesiologists. Other doctors should be consulted only if they have the required qualifications (additional qualifications in emergency medicine or intensive care medicine), if they have mastered the procedures, and if they are able to identify life threatening events early and deal with these according to the specialty standard for anesthesiology” (1, 2).

Further, the indications listed in Box 2 of the article are really indications for general anesthesia with endotracheal intubation.

DOI: 10.3238/arztebl.2010.0785

Prof. Dr. med. Jochen M. Strauß, Berlin (Wissenschaftlicher Arbeitskreis Kinderanästhesie der DGAI)

Prof. Dr. med. Dr. h. c. Hugo Van Aken, Münster (DGAI)

Dr. med. Karin Becke, Nürnberg (Wissenschaftlicher Arbeitskreis Kinderanästhesie der DGAI)

PD Dr. med. Claudia Philippi-Höhne, Leipzig (Wissenschaftlicher Arbeitskreis Kinderanästhesie der DGAI)

On behalf of the authors:

Dipl.-Sozialwirt Holger Sorgatz

Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)

Berufsverband Deutscher Anästhesisten (BDA)

Roritzerstr. 27

90419 Nürnberg, Germany

hsorgatz@dgai-ev.de

1.
Van Aken H, Biermann E, Martin J, et al.: Entschließung zur Analgosedierung für diagnostische und therapeutische Verfahren bei Erwachsenen. Anästh Intensivmed 2010; 51: 598–602.
2.
Philippi-Höhne C, Becke K, Wulff B, Schmitz B, Strauß J, Reinhold P: Entschließung zur Analgosedierung für diagnostische und therapeutische Verfahren im Kindesalter. Anästh Intensivmed 2010; 51: 603–14.
3.
Neuhäuser C, Wagner B, Heckmann M, Wiegand MA, Zimmer KP: Analgesia and Sedation for Painful Interventions in Children and Adolescents. Dtsch Arztebl Int 2010; 107(14): 241–7.
1.Van Aken H, Biermann E, Martin J, et al.: Entschließung zur Analgosedierung für diagnostische und therapeutische Verfahren bei Erwachsenen. Anästh Intensivmed 2010; 51: 598–602.
2.Philippi-Höhne C, Becke K, Wulff B, Schmitz B, Strauß J, Reinhold P: Entschließung zur Analgosedierung für diagnostische und therapeutische Verfahren im Kindesalter. Anästh Intensivmed 2010; 51: 603–14.
3.Neuhäuser C, Wagner B, Heckmann M, Wiegand MA, Zimmer KP: Analgesia and Sedation for Painful Interventions in Children and Adolescents. Dtsch Arztebl Int 2010; 107(14): 241–7.