How is pediatric procedural sedation defined?

Updated: May 08, 2018
  • Author: Wan-Tsu Wendy Chang, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Answer

Answer

The terms used to describe sedation vary. What is more, the health care providers who practice pediatric sedation come from several different fields, including emergency medicine, anesthesiology, intensive care medicine, and radiology. The American College of Emergency Physicians (ACEP), the American Academy of Pediatrics (AAP), and the American Society of Anesthesiology (ASA) have all established guidelines. Consequently, a potential for different practice models exists.

In April 2009, the Consensus Panel on Sedation Research of Pediatric Emergency Research Canada (PERC) and the Pediatric Emergency Care Applied Research Network (PECARN) published recommendations for standardizing terminology and reporting adverse events that involve procedural sedation and analgesia in children. [6] These recommendations will help guide monitoring and quality assurance of pediatric procedural sedation in emergency departments (EDs).

The new recommendation was based upon a systematic review of the literature. The standardization of terminology and the definition of adverse reactions were reached by consensus. An adverse reaction was defined as an event that required intervention from the physician. An adverse reaction had occurred when the physician acted upon specific event(s), such as respiratory compromise, vomiting, cardiovascular compromise, excitatory movements, adverse behavioral reactions, or permanent complication. [6]

For the purposes of the ED practitioner, the term procedural sedation is the most appropriate one to use. Previously used terms, such as conscious sedation and moderate sedation, are misnomers.

Procedural sedation may be defined as the administration of sedative or dissociative agents, with or without analgesics, to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function. Procedural sedation and analgesia is intended to result in a depressed level of consciousness that allows the patient to maintain airway control independently and continuously. Specifically, the drugs, doses, and techniques used are not likely to produce a loss of protective airway reflexes.


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