Doctors warn of 'dangers' of letting non-specialist physicians performing deep sedation on children

Due to a lack of specialist, a new Health Ministry directive is allowing non-specialist physicians to perform the potentially dangerous procedure.

Four year-old Jonathan Nies reacts as he receives a flu vaccination at Children's Hospital Boston in Boston, Massachusetts.  (photo credit: REUTERS)
Four year-old Jonathan Nies reacts as he receives a flu vaccination at Children's Hospital Boston in Boston, Massachusetts.
(photo credit: REUTERS)
The head of the Israel Anesthesiologists Society, Prof.
Benjamin Drenger, voiced his concern over a new Health Ministry director-general directive that would allow sedation of children to be carried out by non-anesthesiologist physicians due to the shortage of specialists in the field.
Drenger, who is head of anesthesiology at Hadassah University Medical Center in Jerusalem’s Ein Kerem, told The Jerusalem Post on Wednesday that using sedation – especially the powerful sedative propofol (Diprivan) – in treating children “is very dangerous. The doctor who gives it must be an expert and trained in the technique and in dealing with a sudden need to resuscitate children.
“We were not consulted about this by the ministry before it issued the directive.”
The ministry document, issued on Wednesday, states it was approved by the National Councils for Surgery, Intensive Care and Pediatrics.
Sedation is needed by children undergoing medical treatment for diagnostic tests or treatment so they will not suffer from pain or anxiety, the ministry said. Children cannot lie still in an MRI or CT scanner without sedation, it continued.
The ministry noted that it is “preferable” for both children and adults to undergo deep sedation at the hands of an anesthesiology specialist, but “due to the shortage” of such professionals, there are not enough to go around for all such procedures.... In certain safe situations, doctors who are not anesthesiologists may do it.”
From now on, hospital physicians who are specialists on pediatric intensive or pediatric urgent medicine may perform sedation in children, the directive said. “In any hospital where children are hospitalized, a pediatric sedation service will be established.
These will decide the type and depth of sedation and who in the hospital can perform these procedures.”
But Drenger and other senior anesthesiologists the Post consulted said that, while they have no problem about senior pediatric specialists doing sedation, they worry about a general paragraph in the directive that allows other physicians to give propofol without the required seniority, knowledge and training.
“In children, the airway is so small, and their metabolism is so high that in a moment, sedation can make them go into hypoxia [lack of oxygen],” Drenger said.
The new directive, he continued, follows another one sent out by the ministry in 2013, based on an original statement going back to 1979.
“The field has lacked regulation for years, and this new directive – which gives some more details – was meant to fix this. But there are not enough details on what non-anesthesiologists can do, who can do it and when, and their training.
If the doctors who will do this do not receive the right training by senior anesthesiologists, it could endanger children as well as adults,” he said.
Drenger added that he saw only a draft of the directive, in which the ministry “completely confused the line between a dentist giving children sedation and an anesthesiologist.
A dentist must not give a child general anesthesia or deep sedation; a dentist should be able to treat a child [only] after he is put under or sedated [by a qualified pediatric anesthesiologist].”
More restrictions on dentists were put in force several years ago when the preschool grandson of former Jerusalem mayor Uri Lupolianski died after being put under sedation by a dentist for major dental work. Drenger added that there is no sub-specialty of anesthesiology for children in Israel.
Drenger has sent the directive to the 15 top committee members in the anesthesiology society, including hospital department heads, and “we will decide what to do.”
He noted that after the ministry allowed non-anesthesiologists to give propofol to adults, “there was the case of a woman two years ago who died as a result.”
The rate of adult patients getting anesthesia from non-anesthesiologists is scores of percent, he said.
He agreed that there are too few anesthesiologists in the country. Soon after the ministry decided to give incentives for young doctors to learn the poorly manned specialty, “the Treasury canceled the incentives,” he said.