Shifting the Paradigm: The Quiet Revolution of Pediatric Procedural Sedation Practice.

Abstract

On April 12, 1945, Dr Gold1 from Weill Cornell Medicine (formerly Cornell University Medical College) presented a review titled “Sedatives and Stimulants in Pediatric Practice” to the section of pediatrics. He stated that he was “disappointed indeed to learn how scant were the revelations of pediatric views on these matters” and then reviewed the primary sedatives of that time for children (barbiturates and chloral hydrate). Over the next 50 years, the vast majority of “conscious” sedation in pediatrics was still being provided with barbiturates and chloral hydrate. Because of this lack of evolution, many of the seminal articles that have been used to guide the mechanics of pediatric sedation practice emanated from 2 sources: data from sedated procedures performed with these traditional long-acting agents and data from general anesthetic cases that were extrapolated to be relevant to procedural sedation. One issue that has been largely governed by these data sets is the risk of apnea and need for prolonged observation in former term and preterm infants after a sedated procedure. The literature regarding the risk of postanesthetic apnea in infants is robust. Infants who were born prematurely carry the most notable risk, as has been described in a number of reports.2–6 Apnea has also been seen postoperatively in term infants with no previous history or known risk factors for apnea.7 In a large, multicenter review in which researchers examined risk factors for postoperative apnea in former preterm infants, postconceptual age (PCA), gestational age, and continued use of a home …