By Leslie Coplin, Executive Editor, AHC Media

The American Academy of Pediatrics and the American Academy of Pediatric Dentistry issued updated clinical guidelines for delivering safe sedation to pediatric patients before, during, and after diagnostic and therapeutic procedures.

Over the past 20 years, the number of procedures performed on children in outpatient settings has increased, leading to need for increased awareness of the importance of providing safe sedation. The guidelines include two updates to sedation procedures.

First, children who are deeply or moderately sedated should have capnography monitoring to measure expired carbon dioxide and ensure airway patency and gas exchange. Second, the assistant to the person monitoring sedation is required to have pediatric advanced life support training.

Other key highlights of the guidelines include:

  • no administration of sedating medication without the safety net of medical/dental supervision;
  • careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications;
  • appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure;
  • a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction;
  • a clear understanding of the medication’s pharmacokinetic and pharmacodynamic effects and drug interactions;
  • appropriate training and skills in airway management to allow rescue of the patient;
  • age- and size-appropriate equipment for airway management and venous access;
  • appropriate medications and reversal agents;
  • sufficient numbers of staff to both carry out the procedure and monitor the patient;
  • appropriate physiologic monitoring during and after the procedure;
  • a properly equipped and staffed recovery area;
  • recovery to the presedation level of consciousness before discharge from medical/dental supervision; and
  • appropriate discharge instructions.

“Sedation is important, but safe sedation is critical,” says Ann M. Dietrich, MD, FAAP, FACEP, editor of Pediatric Emergency Medicine Reports. “These guidelines help ensure excellence in care.”

A complete review of procedural sedation will appear in Pediatric Emergency Medicine Reports later this year.