• 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 ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPediatrics Full Site: One-Year Subscription
Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.
Pay Per View: Timed Access to all of AccessPediatrics
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.