Shanghai, March 25 — As living standards improve and medical science advances, the medical model has shifted from the biomedical model to the bio-psycho-social medical model, and comfort-oriented medical care has emerged in response. For pediatric patients, what exactly is comfort-oriented medical care?

Zheng Jijian, Director of the Anesthesiology Department at the National Children's Medical Center (Shanghai) and Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University School of Medicine, pointed out that comfort-oriented medical care for children is a rigid demand, because children have poor cooperation ability and often cannot cooperate with various diagnostic examinations and therapeutic procedures while awake.

According to the introduction, moderate-to-deep sedation/analgesia in children, also known as pediatric procedural sedation/analgesia, is currently the most commonly used pediatric comfort-oriented medical technique: through drug-induced central nervous system inhibition, the child falls asleep quietly and becomes less responsive to external stimuli, helping the child complete various diagnostic and therapeutic procedures.

"It doesn't matter if a child is nervous and anxious — what child isn't nervous, anxious, or afraid when going to the hospital for an examination?" "Moderate-to-deep sedation/analgesia is a form of general anesthesia that will cause a decline in children's learning ability, so its use should be avoided as much as possible." "Comfort-oriented medical care is just sleep, with no risk." These are common thoughts among parents or guardians of pediatric patients. In an interview on the 25th, Zheng Jijian stated bluntly: "All of the above statements are misconceptions."

It is understood that pediatric sedation includes four levels: light sedation, moderate sedation, deep sedation, and general anesthesia, which respectively meet the sedation/analgesia needs of different diagnostic and therapeutic procedures. Among them, moderate-to-deep sedation is suitable for sedation during pediatric echocardiography, CT, MRI, and other imaging examinations as well as endoscopy, and is the most widely used in clinical practice.

"It doesn't matter if a child is nervous and anxious — what child isn't nervous, anxious, or afraid when going to the hospital for an examination?" In response, Zheng Jijian said that, in fact, the psychological impact of medical procedures and examinations on children is usually quite serious and may well persist long-term. Many children, even after growing up, still have a marked fear of "white coats" and hospitals. For example, during high-end imaging examinations such as CT and MRI, patients undergo examinations accompanied by noise in a narrow, enclosed space, and coupled with worries about an uncertain condition, children will experience a sense of fear more severe than that of adult patients.

"Moderate-to-deep sedation/analgesia is a form of general anesthesia that will cause a decline in children's learning ability, so its use should be avoided as much as possible." In response, Zheng Jijian said this is also a misunderstanding. Moderate-to-deep sedation/analgesia is relatively light or mild general anesthesia and does not require endotracheal intubation. In recent years, a large number of clinical studies have not found that general anesthetics affect children's intelligence or learning ability. Therefore, parents need not worry about the impact of general anesthesia on intelligence and learning ability. Early diagnosis and early treatment of pediatric diseases are more important for the long-term prognosis of the child.

"Comfort-oriented medical care is just sleep, with no risk." Regarding this statement, the expert explained that, unlike risk-free sleep, pediatric comfort-oriented care is drug-induced moderate-to-deep sleep and carries certain risks, especially for children who require imaging examinations to confirm the diagnosis, assess disease severity, and identify concomitant diseases. In addition, the level of sedation may shift without any warning, leading to respiratory and circulatory depression in the child. With the introduction of new sedative drugs and techniques, while ensuring rapid and successful sedation in children, new problems may also arise. Zheng Jijian said that although risks rarely occur, they still exist, which requires parents or guardians to strictly follow the scheduled medical orders and appropriately fast from food and drink or/and undergo sleep deprivation. Therefore, pediatric comfort-oriented medical care needs to be carried out at qualified professional medical institutions.