Procedural Sedation:Pediatric

Considerations

Deb Civello, RN, CPEN, CCRN

Connecticut Children’s Medical Center

March 24, 2009

Objectives

1. The participant will identify at least 3 anatomical differences between children and adults that may increase risk for complications.

2. The participant will list at least 3 words/phrases to avoid when talking with young children about medical procedures.

3. The participant will describe the advantages and disadvantages of the most common medications used in pediatric procedural sedation.

So, you have a 6 month old who needs to be sedated…..

How many of you

feel like this??

Kids Are Different….

It’s all about the “P’s” and an “A”

• Provider preparation

• Patient preparation

• Pain control and adequate sedation

• Anticipation

• Post procedure care

Provider Preparation

• Physical exam

• History

• Weight

• Equipment

• Room set-up

Patient Preparation

• Timing is everything!!

• Start with what the patient knows

• Include the parent/guardian

• Use props/manipulatives

• Watch your language

• Give choices when possible

Speak

no

evil!

Medications

• Analgesics

• Sedatives

• Anxiolytics

• Sedative-hypnotics

• Dissociative anesthetic

• Anesthetics

Analgesics

• Locals• Morphine:

– ↑’d histamine release, ↓’d BP– Duration– Side Effects

• Fentanyl:– Less histamine release, less hemodynamic

effects– Duration– Side effects

Sedatives/Anxiolytics

• Benzodiazepines– Versed– Great safety profile

• Barbiturates– Pentobarbital

Sedative-Hypnotic

• Etomidate– Rapid onset, short duration– Cardiovascular stability– No analgesic activity– Side effects– Great for short procedures

Dissociative Anesthetic

• Ketamine– Analgesic, amnesic, sedative properties,

without loss of protective airway reflexes– ↑’s ICP, intraocular pressure– ↑’s oral secretions– Side effects

Propofol

• Quick onset and offset

• Antiemetic properties

• Side effects

• Consider capnography

Combos

• Versed/fentanyl

• Versed/morphine

• Ketamine/atropine/versed

• Etomidate/fentanyl

• “Ketofol”

Anticipation

• What’s the worst that can happen?

• What will I do about it?

Pop Quiz!

• What are the 2 times during the process that a pediatric patient is most like to experience respiratory depression?

Goals

• Maintain patient safety

• Provide effective pain control

• Reduce anxiety and psychological stress

• Promote conditions conducive to successful performance of the procedure

Discharge Tips

• Back to baseline!

• Written instructions, including medications/doses/times

• Safety issues