Patient Comfort Key for Pediatric Sedation Program

Girl with broken arm; UW Health Pediatric Sedation Program ensures patient comfortMADISON - When a child has cancer, the last thing a family and child should feel stressed about is whether the procedures will hurt. And thanks to American Family Children's Hospital's Pediatric Sedation program, they do not have to worry.

The program, located in the Diagnostic and Therapy Center on the first floor of American Family Children's Hospital, provides sedation for children receiving spinal taps, bone marrow biopsies, radiology procedures, even those undergoing painful orthopedic procedures. Roughly 1,600 sedations, including those for children with cancer, are performed there each year.

"Twenty years ago it was not uncommon for children undergoing painful cancer procedures to just be held down," commented Greg Hollman, MD, director of the Diagnostic and Therapy Center. "Today, we can make them comfortable and help alleviate any discomfort resulting from a painful procedure."
Patient Comfort Extremely Important
Patient comfort is extremely important to the team of nurses and physicians within the sedation program and it was one of the motivations behind their recent research on a sedation regimen for children with cancer requiring lumbar punctures (spinal taps). Their research study recently won the Most Outstanding Abstract at the Third International Multidisciplinary Conference on Pediatric Sedation.

"We studied two different sedation regimens in children who were undergoing spinal taps for their cancer treatment," explained Dr. Hollman. "These are painful procedures and patients can undergo at least 10 spinal taps in their first year after being diagnosed."

During a spinal tap, a pediatric oncologist puts a needle in the child's back to collect spinal fluid and then administer chemotherapy. The child has to curl up on his side while the procedure is being done. It's a very stressful event for both the patient and family.

"The way we devised the study," said Dr. Hollman, "is that at the conclusion, patients were allowed to select the sedative regimen of their choice, and that is what they would receive from then on. So it was nice that patients and families really got something out of the study that would benefit them throughout their cancer therapy."

During the course of the controlled study, patients were either given propofol – a sedative with no pain effects – combined with either a placebo or with fentanyl, a pain killer. Dr. Hollman and his colleagues found that the combination of propofol and fentanyl had several benefits – it was safer, patients recovered faster, and there were fewer side effects. Also, most families preferred the combination of the two (propofol and fentanyl) because of better recovery patterns.

Procedures Become Routine

Parents are able to be with children at all points during a sedation procedure. Having parents directly involved with their child's care is a fundamental part of the program's philosophy.

"Often families will tell us that hearing about sedation and the procedures is nerve-wracking," said Dr. Hollman, "but once they experience it, realize what we do to make their child as comfortable as possible, it allays a lot of their fears. After awhile, for many it just becomes routine."

The Pediatric Sedation program began in 1991, due in part to a need to improve the success of children receiving MRI scans. The program has since grown from a two-room space to a seven-bed facility treating far more than just patients needing MRI scans.

"It really was a case of 'if you build it they will come'," joked Dr. Hollman. "I don't think any of us anticipated the number and range of patients we'd be treating. And it continues to grow as providers look to safely perform procedures that might have originally been done using anesthesia."

A Unique Program
Dr. Hollman and his associates, including Devon Christenson, NP, have served as consultants to a number of institutions across the country, including Children's Hospital of Wisconsin, Austin Children's Hospital, Minneapolis Children's Hospital, the University of Oklahoma and others. 

"It is unclear how many programs there are like us in the country," explained Dr. Hollman. "We are a centralized program, which I think is unique, meaning any child who needs sedation, whether inpatient or outpatient, comes to us. Most institutions instead have sedation services affiliated with different areas. So radiology, for example, would do their own, oncology, etc. Here at American Family Children's Hospital, we can effectively provide services across programs."

And they continue to investigate ways to provide those services and meet patient needs more effectively. According to Dr. Hollman, "Our mission is safe, effective, and accessible sedation."

The program is currently in the developmental stages of a nitrous-oxide sedation regimen.

"It's a relatively new concept," said Dr. Hollman. "To our knowledge there are no pediatric sedation programs using nitrous oxide in Wisconsin. There are a lot of children who are nervous about getting a blood draw, Foley catheter, or IV, for example. So for very quick procedures, we know we could do better in making the patient more comfortable. We're hoping the use of nitrous oxide can do that."

And that is what continues to drive Dr. Hollman and the staff of the Pediatric Sedation Program – making patients more comfortable so they can focus on their healing.

"There is a great article written in 1997 by a pediatrician who is also a mom whose two-year-old was diagnosed with cancer. In it, she describes the top ten things families want for their child undergoing cancer treatment. Number one on the list is 'make sure pain is effectively controlled.' That's our primary goal. And it's nice to know we can take care of such a high priority for families so they don't even have to have it on their list anymore," said Dr. Hollman. "They can just focus on getting better."



Date Published: 10/14/2008

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