Thank you Ian.
Phil, the literature that Cliff quoted is very persuasive; Green must be
considered a world authority on this subject now. Closer to home, my
ex-registrar, Andres Martin, CTR'd this subject to death a few years ago,
plus a few presentations etc. He even introduced the idea to Ffion at the
London, although I hear she has since met with considerable local resistance
to its use, which is sad. Anyway, Andres has probably read and digested
every paper ever written on this subject and I'm sure he'd be happy to email
something to you when he reads this later today.
I partly blame Tom for the way these guidelines went. Much as I respect the
guy, particularly when it comes to matters surgical, I get the impression he
did not consult widely when it came to matters of sedation in kids, and I
know he is personally against its use. He reads this list from time to time
so he may well have another slant on the subject...
In my own unit we have never had any trouble from the anaesthetists when it
comes to the use of ketamine. That's largely because we have never involved
them! Why should we ask "permission" from a specialty that uses much less
ketamine than we do? Same goes for Bier's block; we have much more expertise
in this area than any anaesthetist, so we don't involve them.
As the "emergency physicians" of tomorrow, we need to grasp some expertise
for ourselves; we shouldn't have to wait for others to show us the way.
Adrian Fogarty
----- Original Message -----
From: "Maconochie, I K" <[log in to unmask]>
To: "'Adrian Fogarty '" <[log in to unmask]>
Cc: <[log in to unmask]>
Sent: Wednesday, January 15, 2003 8:35 AM
Subject: RE: SIGN Paediatric Sedation Guidelines
> The Royal College of Paediatrics and Child Health have stated their
> concerns to the SIGN group re the SIGN Paediatric Guidelines. These have
> also been transmitted to the Scottish equivalent of Dept of Health which
has
> funded the development of the guidelines.
> As one of the reviewers of the guidelines for the College I found them to
be
> inaccurate and the evidence cited in many cases did not support the
> statements. There were also sins of omission as has been noted.
> This should not negate the need for developing guidelines but show that
care
> must be taken with reading anything! and having a healthy septicism- we
all
> need to make up our own mind and look in an appropriately critical way at
> the things we are told!
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