Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016

Abstract

The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age-and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, suffi cient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the

Sedation for paediatric auditory electrophysiology in South Africa

“…7,8,15,16 This is especially important in a South African context where the child might be carried on the parent's back, as there is an increased possibility of airway obstruction due to the possibility of prolonged drug effects. 9 Chloral hydrate, used for four children (8%) in our sample, has recently been reclassified as a Section 21 drug in South Africa.…”

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

“…For this reason, endoscopy in children is almost always performed using either deep sedation or anaesthesia (which have their own associated risks 32 ). It would therefore be ethically difficult to undertake such an invasive procedure for research purposes in asymptomatic infants who would derive no immediate benefit.…”

Radiation Therapy for Children: Periprocedural Anaesthetic Concerns

“…The younger age group (2-5 years) may not readily accept the strange surroundings and separation from the caregivers. Fasting should be as per standard American Society of Anaesthesiologists (ASA) guidelines, 2 hours for clear liquids, 4 hours breast milk and 6 hours for formula feed and light meal [4]. Written informed consent should be taken explaining about the procedure, anaesthesia/deep sedation and need for placement of advanced airway if needed.…”

“…Written informed consent should be taken explaining about the procedure, anaesthesia/deep sedation and need for placement of advanced airway if needed. 4 The use of supraglottic airways devices is increasing as we can avoid the complications related to endotracheal intubation.…”

“…M-monitors and special equipment (defibrillators). 4 Monitoring always remains an issue as the anesthesiologist is away from the patient during the procedure, has to rely on slave monitors placed in the radiation suite. Though, there are no defined guidelines for monitoring during radiation therapy.…”