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Procedural Sedation: Pediatric Considerations

Procedural Sedation: Pediatric Considerations. Deb Civello, RN, CPEN, CCRN Connecticut Children’s Medical Center March 24, 2009. Objectives. The participant will identify at least 3 anatomical differences between children and adults that may increase risk for complications.

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Procedural Sedation: Pediatric Considerations

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  1. Procedural Sedation:Pediatric Considerations Deb Civello, RN, CPEN, CCRN Connecticut Children’s Medical Center March 24, 2009

  2. Objectives • The participant will identify at least 3 anatomical differences between children and adults that may increase risk for complications. • The participant will list at least 3 words/phrases to avoid when talking with young children about medical procedures. 3. The participant will describe the advantages and disadvantages of the most common medications used in pediatric procedural sedation.

  3. How many of you feel like this?? So, you have a 6 month old who needs to be sedated…..

  4. Kids Are Different….

  5. It’s all about the “P’s” and an “A” • Provider preparation • Patient preparation • Pain control and adequate sedation • Anticipation • Post procedure care

  6. Provider Preparation • Physical exam • History • Weight • Equipment • Room set-up

  7. Patient Preparation • Timing is everything!! • Start with what the patient knows • Include the parent/guardian • Use props/manipulatives • Watch your language • Give choices when possible

  8. Speak no evil!

  9. Medications • Analgesics • Sedatives • Anxiolytics • Sedative-hypnotics • Dissociative anesthetic • Anesthetics

  10. Analgesics • Locals • Morphine: • ↑’d histamine release, ↓’d BP • Duration • Side Effects • Fentanyl: • Less histamine release, less hemodynamic effects • Duration • Side effects

  11. Sedatives/Anxiolytics • Benzodiazepines • Versed • Great safety profile • Barbiturates • Pentobarbital

  12. Sedative-Hypnotic • Etomidate • Rapid onset, short duration • Cardiovascular stability • No analgesic activity • Side effects • Great for short procedures

  13. Dissociative Anesthetic • Ketamine • Analgesic, amnesic, sedative properties, without loss of protective airway reflexes • ↑’s ICP, intraocular pressure • ↑’s oral secretions • Side effects

  14. Propofol • Quick onset and offset • Antiemetic properties • Side effects • Consider capnography

  15. Combos • Versed/fentanyl • Versed/morphine • Ketamine/atropine/versed • Etomidate/fentanyl • “Ketofol”

  16. Anticipation • What’s the worst that can happen? • What will I do about it?

  17. Pop Quiz! • What are the 2 times during the process that a pediatric patient is most like to experience respiratory depression?

  18. Goals • Maintain patient safety • Provide effective pain control • Reduce anxiety and psychological stress • Promote conditions conducive to successful performance of the procedure

  19. Discharge Tips • Back to baseline! • Written instructions, including medications/doses/times • Safety issues

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