Sedation and analgesia for minor pediatric procedures

Owing to recent emphasis upon the benefits of effective pain management, parents and health care providers expect infants and children to receive safe, effective sedation and analgesia for diagnostic and therapeutic procedures. The Committee on Drugs of the American Academy of Pediatrics has addressed the issue of safety in its recently revised guidelines for monitoring and management of patients undergoing sedation for procedures. Patients undergoing emergency procedures present additional problems because of the limited opportunity to optimally prepare patients and families. Today, managing children undergoing invasive procedures can include the use of sedatives, analgesics, anesthetics, and nonpharmacologic strategies. New formulations of local and topical anesthetics have enhanced their efficacy and reduced pain associated with administration. Innovations in the administration of sedatives and analgesics, as well as antagonists, have enhanced both efficacy and safety. This article reviews recommended guidelines for monitoring and management of patients undergoing sedation for minor procedures and discusses various sedative, analgesic, and anesthetic alternatives available to clinicians.