Introduction to Procedural Sedation Within and Outside the ICU

Pediatric procedural sedation is a high-risk clinical activity that is ubiquitous in any hospital that cares for children. While no one pediatric subspecialty inherently owns sedation, PCCM physicians are frequently at the center of providing procedural sedation within an institution. On the surface, PCCM physicians, by virtue of their training, experience, and expertise, are well suited to perform procedural sedation on children. Yet, like many skills and competencies required in critical care, procedural sedation poses a number of special requirements and challenges to the PCCM practitioner. The AAP monitoring and management guidelines for procedural sedation clarify the basic requirements necessary to promote safe sedation. These guidelines define levels of sedation on a continuum from minimal to deep sedation and underscore the importance of being able to rescue patients who progress to a deeper-than-planned level of sedation. Provision of quality sedation practice requires a multifaceted approach to be successful. PCCM practitioners must have the necessary skills and competencies to deliver high-quality sedation. The structure of providing high-quality sedation practice must include a team knowledgeable and skilled in delivering sedation, a setting conducive to conducting safe and effective sedation and an organization of institutional policies and procedures that addresses quality of sedation practice. Finally, the process of promoting high-quality procedural sedation must be mindful to the ergonomic weaknesses to patient safety inherent within an institution's framework and the importance of promoting high-quality teamwork, designing an effective physical layout, and reducing the frequency and impact of extraneous distractions.