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Simulators can improve sedation safety

At DHMC, patient simulators are being used as "crash-test dummies" to see how well health-care teams respond to pediatric sedation emergencies. There are medications that can alleviate the pain and anxiety that children experience when undergoing procedures such as bone marrow biopsies or spinal taps. However, complications like respiratory depression, the slowing or stopping of breathing, may occur as a result.

In a recent paper published in Anesthesia and Analgesia, George Blike, M.D., and colleagues showed that patient simulators—high-tech mannequins—can be used to assess medical teams' ability to rescue sedated patients from life-threatening complications. That lets them identify and thus correct errors.

Previous studies by Blike and a fellow DHMC anesthesiologist, Joseph Cravero, M.D., have shown that clinicians "were undertreating pain" in children, explains Blike. That's because while doctors want to make children as comfortable as possible, they of course are reluctant to risk serious complications or even death.

"If we were going to get people to be more aggressive and not undertreat pain any longer, we had to address the fear of overdose and the fear of sedation complications," says Blike. He reasoned that if the rescue response could be studied and improved, then doctors would feel more comfortable using sedating medications.

With the simulator, "we don't have to wait for you to have an accident and then try to look at it after the fact," says Blike. The mannequin can be programmed to generate specific sedation-related complications. Then caregivers' responses can be observed and, if necessary, improved before they have to handle such emergencies in real patients.

Signs: In this study, a life-like pediatric mannequin was programmed to respond like a four-year-old child experiencing respiratory depression as a result of having been sedated. The "patient" showed low blood-oxygen levels and a slowed heartbeat. If the team managed the respiratory depression appropriately by opening the airway and providing ventilation in a timely manner, the simulator's vital signs improved. If the team failed to resuscitate the "patient," its vital signs remained low. In a real patient, that could lead to brain damage or death.

Anesthesiologist Blike demonstrates use of emergency airway equipment on a simulated patient.

"We are not as prepared for critical incidents related to sedation as we might think," says Cravero. Problems identified by the study included not having emergency airway equipment set up and not calling for help soon enough. The researchers also found that caregivers who perform this type of rescue regularly had more success.

"Powerful technology," like specially programmed simulators, "gives you a wealth of information about your vulnerabilities so you can take corrective action—and that's how you create safety," concludes Blike.

Kristen Garner

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