Pediatric Sedation

What is sedation?
Providing sedation means a child is given medicine to make the child more relaxed. When a child is sedated,
he/she will better tolerate a medical procedure and will probably not remember the procedure. If the
procedure is painful, medicine to relieve the pain may also be given. Depending upon the level of sedation,
the child may be conscious and able to talk to us, or may be deeply asleep but still breathing on their own.
Are there different levels of sedation?
There are three different levels of sedation that are defined by the American Academy of Pediatrics. The
sedation physician will discuss the level of sedation that will be required based on the child and the
procedure being performed. Please realize that these definitions represent a range of sedation and that
sedation is a continuum rather than clearly defined levels. The following descriptions may help in
understanding sedation levels:
Minimal Sedation
The patient responds normally to verbal commands. Minimal sedation relieves patient anxiety
and is the typical level for cystograms and other minor procedures.
Moderate Sedation
Patients respond to stimulation but may be drowsy. Moderate sedation is a typical level
for laceration repair or other minor emergency procedures. Sedation medicine is
given by mouth or intravenously depending on the test or procedure. Most EEG’s
can be done with medicine by mouth but painful procedures typically require
IV sedation medicine.
Deep Sedation
The patient is asleep and lies still but can be aroused by repeated
stimulation. Deep sedation is the typical level for
MRI, CT scan, bone marrow tests, spinal taps and
other procedures.
SPS
safe and sound
SOCIETY FOR PEDIATRIC SEDATION
SOCIETY FOR
PEDIATRIC SEDATION
2209 Dickens Rd.
Richmond, Va 23230-2005
(804) 565-6354 • Fax: (804) 282-0090
www.pedsedation.org
F r e q u e n t ly A s k e d Q u e s t i o n s
How does sedation differ from general anesthesia?
Sedation is different from general anesthesia. With general anesthesia, the patient will be completely unresponsive
even to painful stimulation and may need assistance from a ventilator (breathing machine). A sedated child
should react to a painful stimulus and should be breathing on his or her own. Please be aware that children, who
progress past the level of deep sedation described above, are under general anesthesia.
Is sedation right for every child and every test?
No, sedation is only right for some children and is only needed for some tests. For example, if your child has
significant medical problems, sedation may expose them to significant risk. If this is the case, it may be best for
your child to receive general anesthesia with an anesthesiologist (see below). Sedation is particularly good for
minimally invasive or non-invasive tests. Procedures that require more than two or three hours, or procedures
that involve severe pain are most often done under general anesthesia. For example, an appendectomy requires
general anesthesia, but lying still for an MRI can often be done with sedation.
Also, minor tests can often be successfully accomplished without any medication. Distraction techniques and
local anesthetics are often all that is needed for blood collection, insertion of an intravenous catheter, or a quick
CT scan.
What is a pediatric sedation service?
A sedation service is a dedicated team of physicians, nurse practitioners and/or nurses who provide sedation.
These sedation teams have developed across the world to improve access to safe sedation for children. In the
past, children were often not sedated for procedures, which left them traumatized, or perhaps resulted in poor
testing conditions. With a sedation service, a sedated patient is under the eye of the sedation team so the person
performing the procedure focuses entirely on conducting the test or procedure.
What type of medical providers supervise sedation services?
Many different pediatric sub-specialties provide or oversee sedation services. The most common pediatric subspecialties
involved are:
Anesthesiologists
Physicians who are trained to care for patients before, during and after surgery. These physicians are the most
skilled in providing anesthesia and caring for the most complex pediatric patients undergoing procedures. Sedation
service physicians, who are not necessarily anesthesiologists, will often refer the most complex pediatric
patients in whom sedation is especially risky to anesthesiologists.
Critical Care
Physicians who are trained to care for the sickest patients in the hospital. Part of their training and practice is
providing sedation and airway management for these very sick patients.
Emergency Medicine
Physicians who are trained to care for the wide variety of patients who present to an emergency department.
These patients include the child with common illnesses and injury to the most critical patients. Part of their
training and practice is providing sedation for procedures and critical airway management.
Hospitalists
Physicians are trained to care for patients in the hospital. This training includes caring for a wide variety of
patients and often includes sedation for minor procedures. With additional training, many hospitalists provide
all levels of sedation.
Advance Practice Nurses (Nurse Practitioner/Certified Registered Nurse Anesthetist)
Nurses have an advanced degree in nursing and receive additional sedation training while working in collaboration
with the sub-specialty physicians above to provide sedation services. Sedation provision may occur with
both a physician and an APN present or may be provided in its entirety by an APN alone.
Some common questions to consider before your child is sedated
Does every patient and test require sedation?
No. Although sedation services are working to minimize the risks, there are risks related to sedation, so your
physician will discuss with you whether they feel your child needs sedation for their test or procedure. This will
depend on the age of your child, their medical problems and the test your child will be having. Many children
will be able to have their test with the help of distraction (playing with a toy).
What can my child eat or drink before sedation?
These guidelines vary slightly from hospital to hospital. Make sure and check with your hospital to make sure
you follow their guidelines. It is very important that your child does not eat or drink before their test. These
guidelines are set to help make the test as safe as possible for your child.
The general guidelines are as follows, but again please check with your hospital. If these guidelines are not followed
your child’s test will likely need to be rescheduled!!
• No solid food for six to eight (6-8) hours prior to the procedure
• Infants may have milk or formula six (6) hours before the procedure
• Infants may have breast milk until four (4) hours before the procedure
• All patients may have clear liquids until two (2) hours before the procedure. No gum chewing or hard candy
is allowed within two hours of the sedation.
How can I prepare my child and myself for the sedation
experience?
Please DO the following before a sedation experience:
• Bring a list of your child’s medications, any allergies and health problems with you to your appointment.
• Remove any metal from your child (earrings, necklace, watch, hair-ties, etc.) if having an MRI. The MRI
magnet is ALWAYS on, and these objects can be harmful for your child and the medical staff.
•If your child has a favorite blanket or special stuffed animal, bring it to the hospital with you. Again, make
sure it has no metal parts.
• Arrive early for the appointment for any pre-sedation procedures.
• If your child takes medication, please check with the hospital to see if you should give them their medication.
• For your child’s safety, follow all pre-sedation instructions provided to you. Some of the instructions prevent
further illness and others help keep the time of the procedure to a minimum.
• Schedule your day to include a recovery period after the procedure. Depending on the medication with which
your child is sedated, this may range from 30 minutes to several hours. There are important criteria your
child must meet so they can be safely discharged home. Meeting these criteria may take some time, but it is
important for your child’s safety.
Please DO NOT do the following before a sedation experience:
• Plan other commitments around the time of testing. Depending on the test for which your child is scheduled,
the procedure may take 30 minutes to several hours. So please arrive on time and plan to be at the hospital
for a while as the test cannot be rushed.
• Be late. Please arrive on time, arriving late may mean the test or procedure will have to be re-scheduled.
• Break the rules around eating and drinking. For your child’s safety, your child must follow these instructions.
Helpful Hints for MRI Testing
• Before coming to the hospital, talk with your child about things he/she might see or hear. For example, you
might play a game with your child scheduled for an MRI. Using a coffee table at home, drape a blanket over
it with your child lying underneath. Make some type of noises (for example, running a vacuum cleaner, etc.)
while he or she lies still to pretend to be in the MRI. Each time you practice, have your child lie still for longer
periods of time.
• Allow your child to ask questions. We want all patients to understand the testing process and feel confident
and secure.
• Consider that children’s fears are different from those of adults. Most children do not experience claustrophobia
(the fear of closed spaces); they are more concerned about the noise of the machine and having to lie
still.
How do I care for my child after sedation?
Your child will leave the hospital with After Sedation Care Instructions to help you understand the symptoms
your child may experience after the procedure. Your child’s nurse will go over all of the instructions before you
depart. For example, your child will be drowsy when leaving the hospital, so the hospital staff will require that
you carry him/her or use a wheelchair to get to your car.
Activities for after sedation often include the following:
• Please follow the directions from your hospital and ask if you have any questions
• Your child will be drowsy after the procedure. How long this lasts will depend on the medication your child
receives. The sedation nurse will inform you of what to expect based on your child, the medication they received
and the procedure they had done.
• We would advise, if possible, that two adults be with the child to drive home. One adult to drive and one to
sit next to the child to make sure they do not become nauseous or fall asleep in an awkward position.
• A child may be unsteady when walking or crawling and will need protection against injury. An ADULT must
be nearby at all times until the child is fully awake.
• Older children should rest in an area where an adult can supervise. Escort the child when walking (such as
when going to the bathroom).
• A child should not be allowed to perform dangerous activities, such as riding bikes, playing outside, etc., until
back to a normal state of awareness.
• We advise you against taking children to daycare following a procedure. He/she may return to normal activities
on the day after the procedure, once the child has returned to a usual state of alertness and coordination.
• Follow all discharge instructions given to you by your child’s nurse.
Eating and Drinking Instructions after sedation
Infants under 18 months: Begin by feeding juices, formula and breast milk. If no vomiting occurs, continue
with the child’s usual feeding routine.
Children over 18 months: Begin with clear liquids. If no vomiting occurs after 30 minutes, continue with solid
foods.
*If your child does vomit, allow his/her stomach to settle for about 1 hour, then offer clear liquids. Do not force
the child to drink. Have your child drink slowly (about 4-8 ounces over 30 minutes).
Reasons to call your doctor
• You are unable to awaken your child.
• Your child continues to vomit even after following the directions listed above.
• Your child does not return to his/her normal state of alertness and coordination within 24 hours.
• For ANY other emergencies, call 911.
• If you are unable to reach the doctor who performed the test, call your child’s doctor.
• If you cannot reach either and you still have concerns come to the emergency department.