Sedation and analgesia during manipulation in children

Abstract

The article provides an overview of modern methods of sedation and analgesia during therapeutic and diagnostic manipulations in children, indicates indications and contraindications. Special attention is paid to the assessment of sedation and anaesthesia effectiveness, scales used for this purpose in children of different ages are described, criteria of sedation depth are given, equipment and measures necessary to ensure patient safety during manipulation are described. It has been noted that BIS index values correlate with sedation scales in children and adults, but values that determine deep sedation in children are currently not clearly defined, which requires further research. Drugs for sedation, their main characteristics and limitations for use are presented. The differences between sedation and monitored anesthesiology care (MAC), which can be provided only by a qualified anesthesiologist, are described in detail. It has been demonstrated that monitored anesthesiologic care implies deep sedation with control of vital functions, control of breathing and hemodynamics during manipulation, and it is noted that capnography is a mandatory element of monitoring in this type of anesthesiologic care in order to detect apnea as early as possible. Criteria for recovery of consciousness after completion of sedation are specified, which include normal airway, adequate ventilation, stability of hemodynamic, restoration of initial level of consciousness, motor activity and possibility to receive liquids through mouth in absence of vomiting. It is noted that the average time from the end of procedural sedation to the restoration of the original state is about 2 hours.