Safe pediatric procedural sedation and analgesia by anesthesiologists for elective procedures: A clinical practice statement from the European Society for Paediatric Anaesthesiology

Abstract

The growing number of medical procedures performed in children that require cooperation of patients, lack of movement, anxiolysis or/and analgesia triggers the increased need for procedural sedation. This document presents the consensus statement of the European Society for Paediatric Anaesthesiology about the principles connected with the safe management of procedural sedation and analgesia (PSA) by anaesthesiologists for elective procedures in children. It does not aim to provide a legal statement on how and by whom PSA should be performed. The document highlights that any staff taking part in sedation of children must be appropriately trained with the required competencies and must be able to demonstrate regularly that they have maintained their knowledge, skills and clinical experience. The main goal of creating this document was to reflect the opinions of the community of the paediatric anaesthesiologists in Europe regarding how PSA for paediatric patients should be organized to make it safe. K E Y W O R D Sanalgesia, children, diagnostic elective procedure, procedural sedation, safety 584 | ZIELINSKA Et AL.

Midazolam oral solution (Ozalin®): a profile of its use for procedural sedation or premedication before anaesthesia in children

“…Midazolam is very commonly used to provide procedural sedation or premedication before anaesthesia in infants, children and adolescents, due to its sedative properties and its rapid onset and short duration of action [1][2][3][4]. Oral formulations of midazolam are easy to administer, are effective in providing sedation, have minimal effects on recovery times and time to discharge, and are well tolerated, as shown in numerous studies of extemporaneous and marketed oral midazolam solutions/syrups in paediatric patients requiring procedural sedation or premedication before anaesthesia [5][6][7][8][9][10][11][12][13][14].…”

“…Paediatric patients should be assessed before undergoing sedation or anaesthesia, with a multi-disciplinary approach being used to individualize treatment and management, and identify areas requiring special precautions [4]. According to the European Society of Pediatric Anaesthesiology 2019 Clinical Practice statement [4], the drug/technique selected for paediatric procedural sedation depends on the type and length of the procedure, target level of sedation, contraindications to specific drugs, the tolerability of the option, informed child and/or caregiver preference, and the age and level of understanding of the child.…”

Analgosedierung bei kinderkardiologischen Patienten

“…Dem Themenbereich "Analgosedierung bei pädiatrischen Patienten" wurde in den letzten Jahren immer mehr Beachtung geschenkt [10]. Mit der Verfügbarkeit unterschiedlichster diagnostischer und interventioneller Prozeduren in nahezu allen pädiatrischen Altersgruppen geht eine Zunahme an Analgosedierungen (AS) einher, durch die -als sichere und effektive Alternative zu Allgemeinanästhesien -diese Verfahren überhaupt erst möglich werden [7,10,12,23]. Diesem in den letzten Jahren zunehmend gestiegenen Bedarf stehen häufig unzulängliche Kapazitäten der pädiatrischen Abteilungen wie auch im Bereich der Kinderanästhesie gegenüber.…”

“…dem Verhindern unerwünschter Ereignisse/Komplikationen und adäquater Organisation hervor [5]. Mehrere Publikationen weisen auf die zwingende Notwendigkeit der adäquaten Ausstattung des Sedierungsarbeitsplatzes hin [1,5,16,18,21,23]. Auch wenn die in der Regel dezentralen Organisationsstrukturen, die wir mit dieser Umfrage durch etliche unterschiedliche Sedierungsorte belegen konnten, eine Herausforderung für die Kliniken darstellen, gilt es, das Problembewusstsein für eine adäquate Ausstattung weiterzuschärfen und nach Bedarf entsprechend nachzubessern.…”

Clinical practice guidelines in pediatric anesthesia: What constitutes high‐quality guidance?

“…The first, titled The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period, was developed by a taskforce appointed by the Society for Pediatric Anesthesia (SPA) . The second was produced by the European Society for Paediatric Anaesthesiology (ESPA) and is titled Safe pediatric procedural sedation and analgesia by anesthesiologists for elective procedures: A clinical practice statement from the European Society for Paediatric Anaesthesiology . These vastly different documents share a broad aim of improving patient outcomes by making a series of recommendations.…”