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Introduction

Is higher ASA class associated with an increased incidence of adverse events during procedural sedation in a pediatric emergency department?. Pediatr Emerg Care. The airway in patients with craniofacial abnormalities. Incidence and predictors of difficult laryngoscopy in 11, pediatric anesthesia procedures. Incidences and predictors of difficult laryngoscopy in adult patients undergoing general anesthesia: a single-center analysis of , cases. J Anesth. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update Capnography enhances surveillance of respiratory events during procedural sedation: a meta-analysis.

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Teaching sedation and analgesia with simulation. J Clin Monit Comput. The important role of simulation in sedation. Curr Opin Anaesthesiol. Training and credentialing in procedural sedation and analgesia in children: lessons from the United States model.

Virtual reality for pediatric sedation: a randomized controlled trial using simulation. What is the impact of the implementation of an evidence based procedural sedation protocol in the emergency department?. J Clin Trials. Clinical pharmacology of midazolam in infants and children. Clin Pharmacokinet. Comparison of midazolam and diazepam for conscious sedation in the emergency department. Pediatric pain control and conscious sedation: a survey of emergency medicine residencies. Evaluation of rapid sequence intubation in the pediatric emergency department.

Sedation with intravenous midazolam in the pediatric intensive care unit. Clin Pediatr Phila. Intranasal midazolam for premedication of children undergoing day-case anesthesia: comparison of two delivery systems with assessment of intra-observer variability.

Br J Anesth. Clinical implications of pharmacokinetics and pharmacodynamics of procedural sedation agents in children. Curr Opin Pediatr. Lidocaine pretreatment reduces the discomfort of intranasal midazolam administration: a randomized, double-blind, placebo-controlled trial. Intranasal lidocaine and midazolam for procedural sedation in children.

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Analgesia and Sedation for Painful Interventions in Children and Adolescents ()

Crit Care Med. Metabolism of fentanyl, a synthetic opioid analgesic, by human liver microsomes: role of CYP3A4. Drug Metab Dispos. Fentanyl metabolism by human hepatic and intestinal cytochrome PA4: implications for interindividual variability in disposition, efficacy, and drug interactions. Plasma concentrations of fentanyl in infants, children and adults. Can J Anaesth. Randomized clinical trial of nebulized fentanyl citrate versus i. Equivalency of two concentrations of fentanyl administered by the intranasal route for acute analgesia in children in a paediatric emergency department: a randomized controlled trial.

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Effectiveness and safety of fentanyl compared with morphine for out-of-hospital analgesia. Prehosp Emerg Care. Duration of antagonistic effects of nalmefene and naloxone in opiate-induced sedation for emergency department procedures. Am J Emerg. Low-dose naloxone for prophylaxis of postoperative nausea and vomiting: a systematic review and meta-analysis. Clinical practice guideline for emergency department ketamine dissociative sedation: update.

Intravenous vs intramuscular ketamine for pediatric procedural sedation by emergency medicine specialists: a review. Predictors of emesis and recovery agitation with emergency department ketamine sedation: an individual-patient data meta-analysis of 8, children. Optimal dosing of intravenous ketamine for procedural sedation in children in the ED - a randomized controlled trial. Ketamine reduce left ventricular systolic and diastolic function in patients with ischaemic heart disease. Acta Anaesthesiol Scand. Ketamine may be related to reduced ejection fraction in children during the procedural sedation.

Hum Exp Toxicol. What is the nature of the emergence phenomenon when using intravenous or intramuscular ketamine for paediatric procedural sedation?. Emerg Med Australas. Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double-blind, randomized, controlled, emergency department trial. Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures?

A randomized, double-blind, placebo-controlled trial. Subanesthetic doses of ketamine stimulate psychosis in schizophrenia. Predictors of airway and respiratory adverse events with ketamine sedation in the emergency department: an individual-patient data meta-analysis of 8, children. Is atropine needed with ketamine sedation? A prospective, randomised, double blind study. Clinical effects of adjunctive atropine during ketamine sedation in pediatric emergency patients.

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Procedural Sedation For Infants Children And Adolescents 2016

Curr Pharm Des. Pediatric Sedation Research Consortium. Emergency physician-administered propofol sedation: a report on 25, sedations from the pediatric sedation research consortium. Procedural sedation for diagnostic imaging in children by pediatric hospitalists using propofol: analysis of the nature, frequency, and predictors of adverse events and interventions. Comparison of midazolam and propofol for sedation in pediatric diagnostic imaging studies. Postgrad Med. Propofol vs pentobarbital for sedation of children undergoing magnetic resonance imaging: results from the Pediatric Sedation Research Consortium.

Clinical efficacy of dexmedetomidine versus propofol in children undergoing magnetic resonance imaging: a meta-analysis. Int J Clin Exp Med. Is procedural sedation with propofol acceptable for complex imaging? A comparison of short vs. Pediatr Radiol. Prevention of pain on injection of propofol: systematic review and meta-analysis.

Propofol: a review of its role in pediatric anesthesia and sedation. CNS Drugs. Mechanisms whereby propofol mediates peripheral vasodilation in humans. Sympathoinhibition or direct vascular relaxation?. A presedation fluid bolus does not decrease the incidence of propofol-induced hypotension in pediatric patients. There is a need for further research regarding sedation and analgesia practices in India. The ASA guidelines recommended that only personnel with training in the delivery of general anesthesia should administer sedation as it is likely that children may pass into a deeper level of sedation than originally intended.

Though professional skill and knowledge remain the determining factors, the goal should be to practice and promote safe sedation and analgesia.


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The introduction of newer pharmacologic agents and better monitoring devices helped us to achieve this. With an ever increasing load of out of operating room procedures, non-anesthesiologists should be formally trained to deliver PSA and manage complications should they occur. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. Journal List J Pediatr Neurosci v. J Pediatr Neurosci. Charu Mahajan and Hari Hara Dash 1.

Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC.

"Pain and Sedation Assessment and Management" by Susan Hamilton, RN for OPENPediatrics

Abstract A spectrum of conditions requires sedation and analgesia in pediatric population. Keywords: Analgesia, children, procedural sedation. Introduction With the better understanding of the developmental neurobiology, it is now a well recognized fact that nervous system is sufficiently sensitive to nociception even before birth, and thus, children should not be undertreated for pain. Open in a separate window. Table 2 Pain scales.

Pre-sedation assessment for procedure Children undergoing sedation should be evaluated beforehand according to the preoperative assessment guidelines of the American Society of Anesthesiologists ASA. Equipment and emergency drugs It is necessary to have appropriate equipment, monitoring, and reliable back up help before instituting sedation for a procedure in a child.

Monitoring Standard non-invasive monitoring should be used in all patients, which includes ECG, BP, pulse oximetry, respiratory rate, and capnography. Special considerations for infants and children Most analgesics including opioids and local anesthetics are conjugated in the liver. Pharmacology of the drugs The guiding principle for analgesic administration is the step ladder approach to pain. Opioids With the advent of short-acting opioids, morphine is no longer preferred for short procedures.

Barbiturates Pentobarbital produces a deep sleep with minimal movement and is popular for use during radiological non-invasive procedures. Chloral hydrate Chloral hydrate is a pure sedative-hypnotic drug without analgesic properties, once widely used during non-painful diagnostic procedures. Propofol The emergency department, gastroenterology, and critical care literature showed that propofol can be given to children in these settings with good efficacy, apparent safety, and rapid recovery. Etomidate Etomidate has a rapid onset of action, a short duration agent with a relatively mild adverse effect profile.

Dexmedetomidine Dexmedetomidine is a highly selective alpha-2 adrenoreceptor agonist with sedative, anxiolytic, and mild analgesic properties with no depressant effect on respiratory drive. Table 3 Ideal agent for procedural sedation and analgesia. Table 4 Comparative properties of different drugs.

Indian scenario In Indian context, use of agents like remifentanil, dexmedetomidine, and etomidate is restricted due to their non-availability or limited supply. Conclusion Though professional skill and knowledge remain the determining factors, the goal should be to practice and promote safe sedation and analgesia.

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Curr Opin Crit Care. Validation of the bispectral index monitor for measuring the depth of sedation in children. Anesth Analg. Rose JB. Pediatric analgesic pharmacology. In: Litmann RS, editor. Pediatric Anesthesia: The Requisites in Anesthesiology. Philadelphia: Mosby Inc, Elsevier Mosby; Tolerance and analgesic efficacy of a new i.

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