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Sedation of children for technical procedures: current standard of practice
1Department of Pediatrics, Tripler Army Medical Center Honolulu, Hawaii 96859-5000.
Insights
Pediatric sedation practices for diagnostic procedures are guided by institutional policies, prioritizing cardiorespiratory monitoring and trained staff. Chloral hydrate is the most common agent, with few serious side effects reported in children.
Area of Science:
- Pediatric Medicine
- Pharmacology
- Medical Practice Standards
Background:
- Establishing a consistent standard of care for pediatric sedation is crucial for patient safety during diagnostic procedures.
- Variations in sedation practices can impact procedural outcomes and patient recovery.
Purpose of the Study:
- To define the current standard of care for pediatric sedation during painless diagnostic procedures in North America.
- To identify common sedation agents, monitoring practices, and personnel requirements.
Main Methods:
- A questionnaire was distributed to 284 pediatric residency program directors across North America.
- Data from 89 responses were analyzed to determine current sedation practices and policies.
Main Results:
- Pediatric departments predominantly set sedation policies, often with formal guidelines.
- Cardiorespiratory monitoring and trained resuscitation personnel are standard during sedation.
- Chloral hydrate is the most frequently used agent, followed by DPT (Demerol, Phenergan, Thorazine) and pentobarbital.
- Few serious adverse events were reported, though two infant deaths associated with DPT in congenital heart disease were noted.
Conclusions:
- The survey reflects current North American standards for pediatric sedation in diagnostic settings.
- Current practices emphasize monitoring and trained personnel, with chloral hydrate as a primary agent.
- While generally safe, specific agents like DPT warrant caution in high-risk populations such as infants with congenital heart disease.
Abstract:
We sought to define the current standard of care for children undergoing sedation for painless diagnostic procedures by sending questionnaires to 284 pediatric residency program directors in North America. From the 89 responses, we determined that departments of pediatrics set sedation policies for children in most institutions, often with formal written guidelines for these procedures. Most require that children have some form of cardiorespiratory monitoring while under sedation and that they are attended by individuals trained in cardiorespiratory resuscitation until the child is fully recovered. The use of parents to transport and monitor the sedated child is uncommon, and total lack of monitoring is rare. Chloral hydrate in dosages of 25 mg/kg to 100 mg/kg is the most common drug used for sedation; DPT, a combination of parenteral Demerol (meperidine), Phenergan (promethazine), and Thorazine (chlorpromazine), at a maximum dose of 2 mg/1 mg/1 mg/kg is the second; and pentobarbital in a dosage of 5 mg/kg to 7 mg/kg is the third. These sedation regimens were associated with few serious side effects, except that two deaths were reported in infants with congenital heart disease who were sedated with DPT. We believe this survey may reflect the current standard of practice for sedation in North American infants and children undergoing diagnostic procedures.