Pediatric Sedation and Distraction

Abstract

As more procedures for children are being done outside the operating room by nonanesthesiologists, the use of procedural sedation is becomingmore common. Pain, anxiety, andmotion control must be accomplished by the team providing the sedation to allow the patient to successfully complete the procedure. Pediatric nurses are called upon to help in providing sedation or in aiding in the recovery. For many years, children were not provided with sedation medications during procedures or were not able to be rescued from complications that resulted in death (Cote, Notterman, Karl, Weinberg, & McCloskey, 2000). In the past 10 years, many organizations have reached a consensus on the best way to provide sedation to children in a safe and effective way. The American Academy of Pediatrics, the American Society of Anesthesiologists (ASA), and the American College of Emergency Physicians all developed guidelines for monitoring and managing sedation and recommendations for standards of practice. The Joint Commission has provided standards that must be in place for those who provide sedation; however, they do not offer suggestions on how the personnel should be trained. Recently, the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services made revisions to the Survey Protocol, Regulations and Interpretive Guidelines for Hospitals. The updates were made to clarify the guidance for anesthesia and sedation services, borrowing from definitions from the American Society of Anesthesiologists (DHHS CMS, 2010). These standards clarify that anesthesia services must be well organized and under the direction of a qualified medical doctor or doctor of osteopathic medicine. They also defined the term anesthesia as the administration of medication to produce a blunting or loss of pain perception (analgesia), voluntary and involuntary movements, autonomic function, and memory and/or consciousness. Assistance is required in maintaining a patient's airway; in ventilating the patient during a druginduced depression of neuromuscular function, where cardiovascular function may be impaired; and when surgical procedures would dictate the loss of consciousness. The CMS defined anesthesia services. They broke down hospital anesthesia services into two groups. The first group is under the heading of anesthesia by providing general,