Pediatric Sedation Medications
Key Points
- Careful patient selection and risk assessment essential
- Age-appropriate dosing and monitoring required
- Different levels: minimal, moderate, deep sedation
- NPO guidelines must be followed
- Emergency equipment must be readily available
Indications
- Diagnostic procedures (MRI, CT, endoscopy)
- Therapeutic procedures (fracture reduction, wound care)
- Anxiety management
- Mechanical ventilation
- Status epilepticus
Common Sedative Medications
Benzodiazepines
- Midazolam
- Oral: 0.25-0.5 mg/kg (max 20mg)
- IV: 0.05-0.1 mg/kg
- Intranasal: 0.2-0.3 mg/kg
- Onset: 10-20 min (oral), 3-5 min (IV)
- Diazepam
- Oral: 0.2-0.3 mg/kg
- IV: 0.1-0.2 mg/kg
- Longer duration of action
Non-Benzodiazepine Sedatives
- Dexmedetomidine
- Loading: 1 mcg/kg over 10 minutes
- Maintenance: 0.2-0.7 mcg/kg/hr
- Advantages: Minimal respiratory depression
- Propofol
- Bolus: 1-2 mg/kg
- Infusion: 50-150 mcg/kg/min
- Rapid onset and recovery
Ketamine
- IV dosing:
- Initial: 1-2 mg/kg
- Maintenance: 0.25-1 mg/kg q10-15min
- IM dosing: 4-5 mg/kg
- Unique properties:
- Dissociative anesthesia
- Maintains airway reflexes
- Bronchodilation
Procedures and Guidelines
Pre-Sedation Assessment
- Complete medical history
- Physical examination
- Airway assessment
- ASA classification
- NPO status verification
NPO Guidelines
- Clear liquids: 2 hours
- Breast milk: 4 hours
- Formula/light meals: 6 hours
- Solid foods: 8 hours
Required Equipment
- Appropriate-sized airway equipment
- Suction devices
- Oxygen delivery systems
- Emergency medications
- Monitoring equipment
Monitoring and Complications
Required Monitoring
- Continuous pulse oximetry
- Heart rate and rhythm
- Blood pressure
- Respiratory rate
- End-tidal CO2 when available
- Level of consciousness
Common Complications
- Respiratory
- Oxygen desaturation
- Apnea
- Airway obstruction
- Cardiovascular
- Hypotension
- Bradycardia
- Dysrhythmias
- Other
- Paradoxical reactions
- Emergence reactions (ketamine)
- Nausea and vomiting
Discharge Criteria
- Return to baseline consciousness
- Stable vital signs
- Ability to maintain airway
- Pain adequately controlled
- Nausea/vomiting controlled
- Parent/caregiver education completed
Further Reading
