Preparation for pediatric procedural sedation outside of the operating room
- Joseph P Cravero, MD
Joseph P Cravero, MD
- Children's Hospital Boston
- Harvard Medical School
- Deborah C Hsu, MD, MEd
Deborah C Hsu, MD, MEd
- Associate Professor of Pediatrics, Section of Emergency Medicine
- Baylor College of Medicine
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Adrienne G Randolph, MD, MSc
Adrienne G Randolph, MD, MSc
- Section Editor — Pediatric Critical Care Medicine
- Professor of Anaesthesia and Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The performance of diagnostic and therapeutic procedures in children is safer and more likely to be successful when the patient does not move and when any associated pain and anxiety are effectively controlled. Pharmacologic and nonpharmacologic interventions that consider the child's age, developmental status, and the clinical circumstances are often required to meet these goals . In addition, attention to the treatment of pain and anxiety associated with the child's condition is a requisite of acceptable and compassionate patient care. Specific issues related to the importance of addressing pain and anxiety in emergency medical systems has been emphasized in a clinical report from the American Academy of Pediatrics .
The increased availability of short-acting sedatives along with accurate noninvasive monitoring has enabled effective and safe management of sedation and analgesia outside the operating room . Procedural sedation is an evolving field practiced by a diverse group of practitioners in an expanding variety of clinical settings . Among the challenges that must be addressed, the development of standardized definitions of outcomes, particularly with respect to what constitutes satisfactory fasting for sedation is essential. In addition, there remains a number of guidelines for sedation promulgated by various specialty societies. Unified multidisciplinary guidelines would encourage consistent care across specialties and sedation settings .
This topic reviews the preparation for pediatric procedural sedation, regardless of setting, including assessment of American Society of Anesthesiologists classification and fasting status, and assurance of necessary personnel, equipment, and monitoring.
A discussion of the nonpharmacologic and pharmacologic interventions for pediatric procedural sedation as well as pediatric airway management and rapid sequence intubation are discussed separately. (See "Procedural sedation in children outside of the operating room" and "Emergency endotracheal intubation in children" and "Rapid sequence intubation (RSI) in children".)
GOALS OF SEDATION AND ANALGESIA
Goals of sedation and analgesia for painful procedures are to :
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- GOALS OF SEDATION AND ANALGESIA
- PRE-SEDATION EVALUATION
- Focused medical history
- Fasting and aspiration risk
- - Elective procedures
- - Urgent or emergent procedures
- Risk classification
- Airway assessment
- Informed consent
- Vascular access
- SUMMARY AND RECOMMENDATIONS