It does strike me that dictats from committees such as "only anaesthetists can use anaesthetic drugs" are simply recommendations and probably a bit of a nonsense in medico-legal terms. Even if developed for the best of intentions.
This would require a whole redefinition of medical registration/licensing/prescribing rights
The only way to restrict doctors abilities to use and prescribe medications is to legislate on the ability to prescribe eg in NZ only certain specialists can prescribe some modern expensive specialist medications or the pharmacy simply won't issue them (eg oral cefuroxime can only be prescribed has hospital based respiratory physicians)
However this legislation is designed to control the rampant over prescribing of the latest expensive agents, not least to control the drug budget
Restricting the use of an old , cheap, commonly used agent to sole use by trained (or training?)anaesthetists - not really what prescribing restrictions are all about.
JohnC
conscientious doctors worry about all this, and "scopes of practice" and "recertification"
charlatans do what the hell they like - and usually without exposing themselves the rigours of a post graduate examinations and a training scheme!
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]
Sent: Thursday, 16 January 2003 12:29 p.m.
To: [log in to unmask]
Subject: SIGN paediatric sedation guidelines
My understanding is that BAEM have commissioned a full topic review and
will issue a specilty-specific guideline - as was recommended by SIGN -
which will deal with the Ketamine issue for A&E. This is from personal
communications with BAEM.
Meanwhile it seems many departments are adopting ketamine sedation
techniques, with protocols derived from the published literature or from
communications with the authors...so are you all prepared to post your
protocols/guidelines/parent info sheets? My original email to BAEM was
prompted from a desire to perform national audit of sedation.
Ketamine sedation in children in A&E depts. remains a controversial
subject, there is no getting away from this. We must be robust in our
practice, and be able to present our evidence to the waiting doubters...to
quote Ray McGlone "it will only take one critical incident and the ketamine
debate is over."
As to ketamine sedation in adults...I am now at Preston (woops must change
my signature text) where ketamine analgesia/sedation is now the technique
of choice for manipulation/reduction of very painful orthopaedic injuries
(#-dislocations). My personal view here is that if the procedure is likely
to be so painful that anaesthetic doses of opiates +/- midazolam will be
needed then the options are a) Formal GA - RSI of course - b) Ketamine.
Marten C. Howes MRCP(UK)
Specialist Registrar
Accident and Emergency Medicine
Royal Lancaster Infirmary
Lancashire
LA1 4RP
http://website.lineone.net/~mcglone/
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