To the Editor:--We conducted a survey of pediatric anesthesia services in the United States and Canada to determine which provide epidural analgesia on inpatient floors and what routine monitoring practices are used. Pediatric services with more than 100 beds were identified from the 1992 Manual of the National Association of Children's Hospitals and Related Institutions. A member of the pain service or a pediatric anesthesiologist was interviewed by phone. If any modality of epidural analgesia (single-dose opioid, intermittent-bolus opioid, or continuous infusions of local anesthetic and opioid) was used on the floors, the monitoring survey was completed. The survey consisted of three questions: What continuous monitors (pulse oximetry, apnea, or electrocardiogram) are routinely employed? Which intermittent evaluations (respiratory rate, sedation score, and pain score) are recorded? What is the initial interval between intermittent evaluations?
Seventy-three institutions were eligible for the survey. Fifty-three (73%) interviews were completed. Of the surveyed institutions, 26 had more than 200 pediatric beds and 27 had less than 200 pediatric beds. Of the surveyed institutions, 40 (75%) provided epidural analgesia to children on the inpatient floors. The results of the survey are presented in Table 1and Table 2.
Of hospitals that provide epidural analgesia on regular inpatient units, 92% routinely use continuous monitoring. Continuous monitoring with pulse oximetry alone or combined with apnea monitors was most prevalent (Table 1).
Respiratory rate is assessed and recorded every hour in 85% of the institutions providing epidural analgesia on inpatient units. The initial recordings of the sedation score, pain assessment, and other vital signs tend to be recorded either hourly or at 4-h intervals. Twenty-seven percent of surveyed institutions do not routinely record pain scores (Table 2).
Epidural analgesia is used routinely for children in non-intensive care unit settings. The hourly recording of respiratory rate and the use of continuous monitors are common. The specific choice of continuous monitor(s) and recording of other parameters shows variability of practice, despite the existence of monitoring guidelines. Consensus-based practice guidelines should be developed to ensure the safety of children receiving epidural analgesia in non-intensive care unit settings.
B. Randall Brenn, M.D., John B. Rose, M.D., Departments of Anesthesia and Critical Care, Alfred I. duPont Institute, P.O. Box 269, Wilmington, Delaware 19899, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, Pennsylvania 19107.
(Accepted for publication May 8, 1995.)