A Day in the Life: Sedation Services

Sedation Services may not get as much public attention as Cancer or Cardiology, but it is a godsend for many patients and families. When a child needs to undergo a procedure that might be uncomfortable or intolerable but does not require full general anesthesia, sedation offers a helpful alternative. Sedation relaxes the child and makes him or her insensitive to what is happening without being completely unconscious. And it is usually combined with pain medication. Sedation is essential for painful procedures and can be helpful for even very minor procedures, like an exam, if, for example, the child cannot stand to be touched or is autistic. It’s also used for patients who are getting an MRI or CT scan and may be frightened. The overriding theme of the Sedation Center is compassion—to ease children’s anxiety and avoid pain. And it’s working: Connecticut Children’s Sedation Services has been named a Center of Excellence by the Society for Pediatric Sedation, the only such center in the state.

To get a better sense of what goes on in Sedation Services, we spent a day there. Here, we present some glimpses of the activities that went on during that day.

8:15 AM

Fourteen-month-old Rylon is sitting on a bed in a treatment room in Sedation Services watching all the activity around him. The room is perhaps 12 feet square and has a sliding glass door. Rylon has a beaming smile and seems interested in everything. His mother says that he is a very active child, walking and climbing, and that’s why he’s here today: he broke three of his front teeth in a fall when he was climbing. Those teeth need to come out. The extraction will be done by a team of dental surgeons who have come over from UConn Health because this is a specialty we don’t have. To make the most of their visits, Connecticut Children’s tries to schedule several children who need dental work done on the same day. Rylon is the first of those today.

His mother and father are with him, and so is Jesse Sturm, MD, one of the two sedationists on duty today. Dr. Sturm is talking with the parents and examining Rylon to determine the most appropriate type and dosage of sedative to use. He decides on ketamine and then explains to the parents how it works, what possible side effects and complications are (both very unlikely and minimal). They are clearly very anxious themselves.

Dr. Strum with Rylon and his father — Dr. Sturm examines Rylon to gauge his overall state of health and help determine the appropriate dosage of drugs for him.

For a variety of reasons, parents are not allowed in the treatment room during the procedure itself, but they are there for the sedation. They are, in fact, crucial participants. Rylon’s mom is holding him as Dr. Sturm sprays a little antianxiety drug into his nose, to help him relax as the IV is put in. He’s not happy about this, so his mother distracts him with a video game. After 15 minutes, when the spray has taken effect, a nurse puts in the IV and starts the sedative, while another nurse attaches a pulse oximeter (a clothespin-like device that measures his pulse and blood oxygen) and a series of sensor pads around his body so his vital signs can be followed on a monitor screen. Dr. Sturm is gently holding Rylon’s head and watching him intently as this is all done.

Then the parents leave and the dental team comes in. Rylon’s eyes are open and he is squirming a bit and making noises, so Dr. Sturm increases the amount of sedative while keeping an eye on the monitor to be sure his vital signs are stable. The procedure itself is pretty straightforward, if a little gruesome to watch: a tool to get a firm grip on the tooth and then basic pulling until the tooth comes out. There is, of course, some bleeding, but the nurses staunch the wound with sterile pads. Rylon recovers quickly, and without any unpleasant side effects. He will go home in an hour or so, happy and healthy.

Rylon, a dental and sedation services patient — The goal for every child treated here is for them to be as comfortable as possible. Rylon seems pretty happy here.

10:30 AM

Benjamin is also here for tooth extraction. In his case, the teeth are his adult teeth that are ingrown—growing in the wrong direction. Benjamin is six years old, with a head of lustrous black hair and glasses; a bright, calm child. A Child Life specialist has a stuffed toy dog and real medical equipment that he uses to show him what to expect. Benjamin is so calm that Dr. Sturm tells his parents that he thinks they can forego the nasal spray and go straight to the ketamine IV. Nurses come in, confirm Benjamin’s ID and the procedure to be done, and give him an iPad with a movie to watch while they insert the IV. His mother and the Child Life specialist are talking to him the whole time the nurse is trying to find a vein and insert the IV.

The dental team then comes in and Dr. Sturm invites Ben’s mother to give him a kiss before she leaves. Ben goes slack pretty quickly once the sedative takes effect. His eyes are open, which is a little spooky, since he clearly is not aware of the doctors start working on extracting the three impacted teeth. Because Ben is older than Rylon, it’s quite a bit harder to remove his teeth, and the dentists are working pretty hard to dislodge them. Ben is starting to fuss a little, so Dr. Sturm increases the ketamine dose. He’s gently stroking Ben’s cheeks as the increased dose kicks in and Ben relaxes again. The teeth eventually come out, the parents come in, and Ben starts his recovery. Another successful procedure.

1:00 PM

Josephine is not here for troublesome teeth. She has leukemia and has to come in every three months to have some spinal fluid removed for testing. She is six years old, astonishingly mature and more than a little spunky. She is wearing red socks, leggings, a pink chiffon skirt and a lavender sweater. She originally lost her hair from the chemotherapy, and it has now grown back with a curl, cut in a very fashionable style. She’s a pretty girl, and the haircut is great, but Josephine doesn’t like it. Her mother says, “People stop her on the street to say how much they like her hair, and without missing a beat, she says, ‘You think I would have chosen this?’” She does not want her picture taken today.

At six, Josephine has done this so many times that she seems almost bored by the procedure, and doesn’t say much as she’s waiting for the prep work to be finished. But her mother tells us nonstop stories about things Josephine says and does under other circumstances. An example: “We were doing a procedure at one point, and Josephine said, “What the [expletive] are you doing to me?” I asked her where she heard that word, worried that she would say me, but she said, ‘The bus isn’t all rainbows, you know!’”

Josephine has no noticeable reaction to the IV insertion and quickly goes slack. An oncology nurse opens a lumbar puncture kit, takes out the main tool, a needle with a plastic tube attached to one end. After a minute, clear, viscous fluid drips from the end of that tube into a vial the nurse is holding. Again, Dr. Sturm and the sedation nurses monitor her vital signs and stand ready to make any adjustments needed. As indifferent as Josephine seems, this is not a procedure any child would want to undergo fully conscious.

And that’s the mission of this hospital: so save children from discomfort, pain, and anxiety.