Procedural sedation and analgesia in children

Author(s): Nirupama Kannikeswaran and Nirmala B Bhaya

Providing relief from pain and anxiety associated with diagnostic and therapeutic procedures has become an ethical imperative in children, as well as a measured quality of care from the family perspective. This, along with a tremendous increase in the number of procedures performed in children outside the operating room, has placed an increasing demand for procedural sedation and analgesia (PSA) to be provided by nonanesthesiologists. Safe sedation for children requires a systematic approach with careful pre-sedation assessment and patient selection, appropriate physiologic monitoring during and after the procedure, clear understanding of the pharmacodynamics and pharmacokinetics of sedation medications that are used, and necessary skills to rescue the patient from sedation related adverse outcomes. In this article, we review the indications for PSA in children, the principles of providing safe and effective sedation, including pre-sedation assessment and monitoring during sedation, adverse events related to sedation and pharmacology of commonly used drugs for sedation. In addition, we also present the alternative and adjunctive nonpharmacologic approaches that can be used in children requiring PSA.