Pediatric Sedation

The Center of Procedural Excellence (CoPE) is a six-bed unit within Connecticut Children’s dedicated to providing high-quality procedural sedation for pediatric patients. This is one of only a few centers in New England with space and staff dedicated to non-operating-room pediatric sedation. The CoPE was opened in March 2016 with generous donations from the Connecticut Children’s Foundation and the UConn HuskyThon. The Sedation Service provides comprehensive high-quality care with a focus on the patient and family experience. In 2020, we provided care for over 1,500 patients requiring sedation for procedures outside of the operating room. While Covid-19 temporarily decreased the number of patients we cared for, rapid implementation of a comprehensive pre-arrival testing process allowed us to continue to do our important work in a safe manner.

The Sedation division works with nearly all subspecialties within Connecticut Children’s to provide sedation for painful procedures outside of the operating room including: bone marrow aspiration/biopsy in Oncology patients, kidney biopsies for Nephrology, imaging for Radiology, catheter placement and minor surgical procedures for Urology and Surgery, central line placement for the PICC line service, and vaccination/ lab draws for patients with developmental delays and autism spectrum disorders. Our service utilizes a mixture of intravenous, oral, and inhaled sedative agents to provide mild to deep sedation, scaled to meet the developmental and procedural needs of each patient. This year we were named a Sedation Center of Excellence by the Society for Pediatric Sedation. The Center of Excellence designation is a highly competitive award given annually to centers of pediatric sedation that create an “ideal environment for the delivery of safe, effective, efficient, timely and equitable patient-centered pediatric procedural sedation.” The Society for Pediatric Sedation is the international multidisciplinary leader in the advancement of pediatric sedation. Applications are reviewed in a blinded fashion by a panel of experts and Centers of Excellence designations are awarded for a four-year period, in this case from 2020-2024. We are currently the only pediatric hospital in New England with this Center of Excellence in Pediatric Sedation designation.

We are humbled by our high commendations from patients and families, a testament to our continued efforts to develop a family centered approach to care delivery. To that end, associate medical director Kalyani Raghavan, MBBS, MD, DCH, continues to develop strategies to serve the needs of our patients with autism spectrum disorders. Working with colleagues in Developmental Pediatrics at Connecticut Children’s and with state and national experts, Dr. Raghavan has developed social stories to help prepare patients and families for their procedural sedation. These social stories are available online and can be viewed by families to prepare their child for the visit to Sedation. Dr. Raghavan has received grant funding from Autism Speaks® and other outside foundations to continue her very important work. Further developing her expertise in alternative approaches to management of pain and anxiety, Dr. Raghavan is initiating a program to offer options for aromatherapy for patients hospital-wide. To help families prepare for a visit, our child life specialist is available to call them in advance to help develop individualized approaches with the family’s input.

Members of the Sedation Team are involved in leadership and committees at Connecticut Children’s. Leonard Comeau, MD, is chairperson of the Sedation and Analgesia Committee and is responsible for writing and updating sedation policies, updating and overseeing credentialing of the house staff, and monitoring safety and quality of sedation hospital-wide. Members of the Sedation service also participate on hospital committees focused on pain management, the patient and family experience, pediatric palliative care, and quality and safety.

Education and research remain a significant part of our mission. Faculty-led research has explored the degree of parent and nursing satisfaction with the use of mild sedatives for Emergency Department procedures. Members of our nursing team, Kim Paula-Santos and Fiona Sellew, completed work on a competitive Nursing Research Fellowship to study the use of the sedative dexmedetomidine for use in sedated hearing screens. This work was presented at the annual Society for Pediatric Sedation Meeting in October 2020. Our educational commitment remains strong. Every UConn Pediatric and Emergency Medicine intern (35 per year) spends a week on a dedicated Sedation rotation. Residents participate in all aspects of patient care, are given hands-on training in airway management, and become credentialed to independently provide moderate sedation.

Our mission is to provide the highest quality care for children undergoing tests and procedures outside the operating room. We aim to utilize not just sedation medications but distraction techniques, alternative therapies, and a family centered approach to minimize anxiety and unnecessary discomfort for our patients.

PUBLICATIONS

Hellstrand K, Rogers SR, Sturm JJ. Prevalence of cyberbullying in patients presenting to the pediatric emergency department. Pediatr Emerg Care. 2020 Sept 21. doi: 10.1097/PEC.0000000000002243 PMID: 32970026.

Patel P, Laurich VM, Smith S, Sturm J. Point-of-care influenza testing in the pediatric emergency department. Pediatr Emerg Care. 2020 Nov. doi: 10.1097/ PEC.0000000000002250.

STAFF

Jesse Sturm, MD, MPH, Division Chief Kalyani Raghavan, MBBS, MD, DCH Kathy Kalkbrenner, MD