Pediatric procedural sedation and analgesia outside the operating room: anticipating, avoiding and managing complications

Figures & data

Figure 1. The American Society of Anesthesiology and Joint Commission on Accreditation of Healthcare Organizations definition of sedation (effective 01/01/01).

CV: Cardiovascular.

Table 1. SOAPME check list.

S (Suction)	Size-appropriate suction catheters and functioning suction device
O (Oxygen)	Adequate oxygen supply and functioning flow meters and other devices to allow its delivery
A (Airway)	Age-appropriate airway equipment
P (Pharmacy)	Basic drugs for life support and antagonists
M (Monitors)	Functioning pulse oximeter with size-appropriate oximeter probes and other monitors as indicated for the procedure
E (Equipment)	Special equipment for a pediatric case (e.g., pediatric defibrillator paddles)

Adapted from the American Academy of Pediatrics Committee on Drugs [5].

Table 2. Pharmacological agents used for sedation and their adverse events.

Drugs	Common adverse events
Propofol	Hypoventilation, apnea, hypotension and pain on injection
Midazolam	Respiratory depression, paradoxical excitement and occasional hypotension; reversal agent flumazenil
Fentanyl	Respiratory depression, hypotension/bradycardia and chest wall rigidity; reversal agent nalaxone
Ketamine	Increases heart rate, blood pressure and intracranial pressure, copious secretions and laryngospasm
Chlorol hydrate	Unreliable effects in patients >3 years old, minimal respiratory depression, upper airway obstruction, paradoxical excitement, erratic rectal absorption and oversedation
Methohexital	Hypoventilation, apnea and hypotension
Pentobarbital	Respiratory depression, prolonged duration (4–6 h) and slow wake-up associated with agitation

Activity Evaluation: Where 1 is strongly disagree and 5 is strongly agree

	1	2	3	4	5
1. The activity supported the learning objectives.
2. The material was organized clearly for learning to occur.
3. The content learned from this activity will impact my practice.
4. The activity was presented objectively and free of commercial bias.

American Academy of Pediatrics. Committee on Drugs. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: addendum. Pediatrics110(4), 836–838 (2002).

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