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LETTER TO THE EDITOR

Replacing the Outmoded Term "Nonanesthesiologist"

Departments of Anesthesiology and Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH, joseph.cravero{at}hitchcock.org

In Response:

We would like to thank Drs. Green and Krauss for their thoughtful comments concerning our review article. We would point out the quote "stop calling them non-anesthesiologists" is not from Dr. Epstein, but is actually an excerpt from an article in the ASA newsletter by Bailey (1) cited in his Rovenstine lecture: "Anesthesiologists need to help educate and train their colleagues (we should stop calling them non-anesthesiologists) so that they too can administer safe and effective sedation." We could not agree more. Our call for anesthesiologists to increase involvement in defining the critical skills and knowledge base for pediatric sedation providers is clearly outlined in our article in the section "Sedation Versus General Anesthesia" (2).

In our discussion of current sedation practice, we specifically highlight the work of emergency medicine physicians and intensive care specialists and their leading role with respect to the practice of pediatric sedation. We are happy to refer to them as "colleagues." We used the term "nonanesthesiologists" when referring to trends in practice involving a variety of physician pediatric sedation providers, including intensivists and emergency physicians—but also including pediatric oral surgeons, pediatric dentists, pediatricians, pediatric cardiologists, pediatric pulmonologists, pediatric gastroenterologists, pediatric hematologist/oncologists, and radiologists. Many of these specialists make pediatric sedation a focus of their research and academic pursuits. We believe a large number of these specialists are also "well-trained in airway management, resuscitation, vascular access, and pharmacology." To single out practitioners of emergency medicine and intensivists from this group would surely invite similar letters of objection from members of these pediatric subspecialties. We respectfully maintain our contention that the next important step for anesthesiologists with respect to pediatric sedation practice will be to help define the background and proficiencies that separate our skilled "colleagues" from those providers that require further training and guidance in the safe practice of pediatric sedation.

References

1. Bailey P. Raising better consciousness about sedation guidelines. ASA Newsl 2001;63:37–8.
2. Cravero JP, Blike GT. Review of pediatric sedation. Anesth Analg 2004;99:1355–64.[Abstract/Free Full Text]

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