• A thorough presedation evaluation is necessary
before any drug administration. This screening process concentrates
on past and current medical conditions, previous reactions to sedatives
or to general anesthetics, and known drug allergies.
• A history of snoring, mouth breathing, asthma, or recent upper
respiratory tract infections suggests possible airway obstruction
or increased secretions.
• A history of difficult intubations or sleep apnea may require
referral for consultation with an anesthesiologist or otolaryngologist
(or both) prior to the procedure.
• A focused inspection of the airway must explore potential airway
difficulties due to adenotonsillar hypertrophy, micrognathia, or
other abnormal airway anatomy.
• The cardiovascular assessment should elicit information about
• Congenital heart defects.
• Heart murmurs.
• Presence of a pacemaker.
• Previous cardiovascular surgical procedures.
• Failure of growth.
• Neurologic evaluation includes notation of shunts, neurologic
abnormalities, and seizure disorder.
• Important gastrointestinal issues to address are reflux and liver
• Compromise of renal function and the frequency of dialysis should
• Exposure to infectious diseases should be recorded.
• The presence of an organ transplant must be documented.
• Finally, endocrine screening must evaluate the possibility of
diabetes and questions should be asked about pituitary and thyroid
• The patient’s fasting status should be reviewed before drug
• Clear liquids may be given up to 2 hours prior to sedation in
all age groups.
• Patients at risk for regurgitation or aspiration (eg, children with
known reflux or extreme obesity) may benefit from prolonged fasting
or pharmacologic therapy to reduce gastric volume and acidity.
• Hydration with intravenous fluids is often necessary after prolonged
fasting, particularly in young infants.
• In an emergency department, waiting many hours prior to sedation
may not be an option.
• Although fasting is preferred, there is little evidence to show
patients who have not fasted have worse outcomes, such as aspiration,
than those who fasted.