A Pediatric Nurse Practitioner–Led Moderate Sedation Service: Our 7-Year Experience

The use of moderate sedation in children for the performance of a variety of diagnostic imaging tests and therapeutic interventions outside of the operating room, not directly supervised by an anesthesiologist, has been successful and well-documented in recent years. However, to date, all published reports describe only physicians as the primary provider performing the moderate sedation. In this article, we discuss our development of a nurse practitioner (NP)-led pediatric sedation program and a 7-year review of practice. We discuss the development of our NP-led team including key elements such as necessary personnel, process components, and guidelines for pharmacologic agents. We also present our practice outcomes, demonstrating an annual increase in patient volumes, a procedure success rate of 99.5%, and the occurrence of no major adverse events. NPs are an effective, safe alternative to physicians as the primary provider for this specialty service.     

Propofol-Based Palliative Sedation to Treat Antipsychotic-Resistant Agitated Delirium

Delirium is a common problem in terminally ill patients that is associated with significant distress and, hence, considered a palliative care emergency. The three subtypes of delirium are hyperactive, hypoactive, and mixed, depending on the level of psychomotor activity and arousal disturbance. When agitated delirium becomes refractory in the setting of imminent dying, the agitation may be so severe that palliative sedation (PS) is required. Palliative sedation involves the administration of sedative medications with the purpose of reducing level of consciousness for patients with refractory suffering in the setting of a terminal illness. Propofol is a sedative that has a short duration of action and a very rapid onset. These characteristics make it relatively easy to titrate. Reported doses range from 50 to 70 mg per hour. The authors present a case of antipsychotic-resistant agitated delirium treated with a propofol intravenous infusion.     

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??With the development of medical and health undertakings and people's increasing emphasis on health?? the change of modern lifestyles and the rapid development of modern medicine have led to an increasing number of patients attending oral clinics with systemic diseases. Other systemic diseases due to the use of new drugs and new technologies has put forward new requirements for traditional oral medical services. The development of minimally invasive and comfortable medical services has also put higher demands on the knowledge structure and clinical capabilities of doctors. This article summarizes the mode of treatment of sedation and analgesia in Oral Clinic with Oral Pain Relief Center and describes the model and the techniques it covers.