Assessment and Monitoring of Pediatric Procedural Sedation

As emergency medicine physicians and other nonanesthesiologists continue to take more prominent roles in pediatric procedural sedation and analgesia (PSA), the significance of a standardized approach to insure patient safety becomes paramount. Appropriate preparation includes the recognition of sedation as a continuum and assembling equipment and trained staff accordingly. A detailed focused assessment of a child will help to identify those at risk for adverse events. This assessment will further help the practitioner decide which PSA medication regimen is most appropriate, as well as the most appropriate timing and setting for the procedure. Although no clear relationship exists between preprocedural fasting and increased adverse outcomes, appropriate assessment and risk-benefit analysis should be completed. Informed consent of parents and clarification of sedation expectations remain an important part of any preprocedural routine. Finally, newer modalities such as end-tidal CO₂ and bispectral index monitoring may enhance the safety and refine the use of PSA when used as adjuncts to standard pulse oximetry and hemodynamic monitoring parameters.