Procedural Sedation in Children

Abstract

Children are often fearful of visits to the emergency department (ED) because it represents a potentially painful experience in a foreign environment. Over the past 2 decades, a greater appreciation of the need to maximize patient comfort and minimize anxiety for the entire pediatric age spectrum has led to an appreciation of the role played by anxiolytics, narcotics, and sedatives in reducing unnecessary discomfort during the performance of procedures and radiologic examinations in children. The spectrum of agents available for pediatric procedural sedation and analgesia in the ED has broadened considerably over the past 2 decades. The intramuscular narcotic-phenothiazine “cocktail” has been relegated to historical lore, and the present day practitioner can choose from over a dozen pharmacologic options, enabling some finesse in matching the sedative-analgesic agents and routes of delivery to fit the clinical need. Administration of effective procedural sedation can maximize patient comfort, thus leading to a higher frequency of procedural success. In addition, because medications such as midazolam offer amnesia for the procedure, patients can undergo invasive procedures without building a fear for future patient encounters. Administration of procedural sedation is also often linked with increased parental satisfaction with the ED experience, despite the fact that the administration of sedation can be associated with increased length of stay. For all these reasons, it is safe to say that the administration of procedural sedation has become the standard of care for painful or anxiety producing procedures and certain radiologic studies. This issue of Clinical Pediatric Emergency Medicine is thus dedicated toward broadening practitioner