• Cases that require a relatively motionless child
in order to provide adequate working conditions.
• Invasive procedures, such as laceration repair, lumbar puncture,
and orthopedic procedures.
• Diagnostic imaging studies.
• Due to the risk of oversedation or an allergic response to a sedative,
sedation is indicated only if absolutely necessary.
|• Although there are few absolute contraindications, the points presented here are important to consider when weighing the risks and benefits of the sedation procedure.|
• History of an allergy or other untoward reaction
to previous sedation attempts.
• Facial dysmorphism or deformity or anatomic variation that would
make maintaining airway competency difficult (ie, Pierre Robin syndrome
or Goldenhar syndrome). In these cases, consultation with an anesthesiologist
• The presence of upper respiratory infection.
• Although not an absolute contraindication, sedation should
be approached with caution.
• In a patient with clear lung fields but rhinorrhea, glycopyrrolate
or atropine can be used prior to sedation to aid in drying secretions.
• The presence of lower airway symptoms, such as wheezing.
• For nonemergent sedations, rescheduling should be strongly
• For emergent sedations, pretreatment with nebulized albuterol
and use of ketamine should be considered.
• Vital signs must be assessed before, during,
and after the sedation process.
• Pulse oximetry should be recorded regularly.
• Capnography, while not widely used, had been studied recently
as an adjuvant in monitoring patients during sedation.
• There is some evidence that elevation of carbon dioxide as measured
by inline capnography may be a reliable early indicator of respiratory
compromise from oversedation.
• Loss of airway patency; if unrecognized, hypoventilation or
upper airway obstruction can lead to hypoxemia and respiratory arrest.
• Circulatory collapse can be induced by peripheral vasodilation
and direct myocardial effects of some drugs.
• Potential for aspiration is increased with deep sedation because
the gag reflex is lost.
• Allergic reactions are uncommon but do occur. The physician must
be able to quickly diagnose and intervene if anaphylaxis begins.
• Terms such as “conscious sedation” and “twilight
sleep” are misleading as any degree of sedation has potential
to change to deep anesthesia and must be approached with this in
• Practitioners who sedate patients must be skilled in advanced
airway management, pediatric advanced life support, and in assessment
of patients for changing levels of sedative effects.
• Trained support staff and resuscitation equipment and drugs must
also be immediately available.
• Sedation should be initiated in a controlled environment. No
sedation medications should be given by the parents on the way to
the hospital or office, as was once common.
• Although complications from sedation are infrequent,
the physician must be prepared for any clinical situation.
• In addition to being ...
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