Pediatric procedural sedation and analgesia

Abstract

Procedural sedation and analgesia (PSA) is an evolving field in pediatric emergency medicine. As new drugs breach the boundaries of anesthesia in the Pediatric Emergency Department, parents, patients, and physicians are finding new and more satisfactory methods of sedation. Short acting, rapid onset agents with little or no lingering effects and improved safety profiles are replacing archaic regimens. This article discusses the warning signs and areas of a patient's medical history that are particularly pertinent to procedural sedation and the drugs used. The necessary equipment is detailed to provide the groundwork for implementing safe sedation in children. It is important for practitioners to familiarize themselves with a select few of the PSA drugs, rather than the entire list of sedatives. Those agents most relevant to PSA in the pediatric emergency department are presented.

Effect of Pre-Emptive Paracetamol Infusion on Postoperative Analgesic Consumption in Children Undergoing Elective Herniorrhaphy

“…The use of propofol has met on some resistance. It seems to be an emerging drug in paediatric emergency; however, other medications, such as ketamine, fentanyl, etomidate and midazolam, have proven their utility and safety over time (10)(11)(12).…”

Perbandingan Efektivitas dan Keamanan Kombinasi Ketamin/Midazolam Dibandingkan Ketamin Tunggal sebagai Sedasi pada Anak

“…10 Mekanisme kerja yang menghasilkan efek analgesi yaitu ikatan dengan reseptor N-methyl-D-aspartate (NMDA) sebagai antagonis non kompetitif. Ketamin juga dapat berikatan dengan reseptor lain, seperti reseptor opioid dan muskarinik.…”

“…Awitan kerja obat 1 hingga 3 menit, waktu paruh distribusi 6 hingga 15 menit, dan waktu paruh 1,5 sampai 2 jam. 10,14 Efek amnesia pada midazolam lebih poten daripada efek sedasi sehingga pasien dapat tetap terjaga namun tetap da lam keadaan amnesia terhadap suatu percakapan atau kejadian. Dosis intravena pada anak 0,05-0,1 mg/kg.…”

“…15 Anterograde amnesia merupakan efek yang paling diharapkan dari midazolam karena menyebabkan pasien tidak dapat mengingat prosedur traumatik yang sedang dijalani. 10 Kekurangan midazolam yaitu menyebabkan depresi napas. Kejadian henti napas dapat terjadi pada pemberian dalam dosis besar (di atas 0,3 mg/kg).…”

Intravenous Sedation for Pediatric Gastrointestinal Endoscopy in a Developing Country

“…When administered, the drugs should be given as an appropriate initial dose with subsequent doses until titrated to effect. However, the most important factor is the judgement of the physician (ASA, 2002;Sury, 2004;Cote et al, 2006;Krauss & Green, 2006;Vespasiano et al, 2007;Meredith et al, 2008). Common drug-receptor systems used by anesthesiologists in Thailand include the following: 1.…”