Procedural sedation in children outside of the operating room
- Deborah C Hsu, MD, MEd
Deborah C Hsu, MD, MEd
- Associate Professor of Pediatrics, Section of Emergency Medicine
- Baylor College of Medicine
- Joseph P Cravero, MD
Joseph P Cravero, MD
- Children's Hospital Boston
- Harvard Medical School
- 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 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 and improved sedation training programs 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 are the development of standardized definitions of outcomes, particularly with respect to what constitutes satisfactory sedation and what is an adverse event. In addition there remain a number of guidelines for sedation promulgated by a various specialty societies. Unified guidelines would encourage consistent care across specialties .
This topic reviews the indications, contraindications, and steps for safe performance of procedural sedation in children undergoing diagnostic or therapeutic procedures, regardless of setting.
Pre-sedation evaluation, preparation for procedural sedation, properties of specific agents used for pediatric procedural sedation, strategies for selecting medications for pediatric procedural sedation, pediatric airway management, and sedation in adults are discussed separately:
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- GOALS OF SEDATION AND ANALGESIA
- CONTRAINDICATIONS AND PRECAUTIONS
- PERFORMING PROCEDURAL SEDATION
- Informed consent
- Nonpharmacologic interventions
- Medication administration
- DISCHARGE CRITERIA
- ADVERSE OUTCOMES
- CLINICAL PRACTICE GUIDELINES
- SUMMARY AND RECOMMENDATIONS