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

Objectives 1.The participant will identify at least 3 anatomical differences between children and adults that may increase risk for complications. 2.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.

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

Kids Are Different….

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

Provider Preparation Physical exam History Weight Equipment Room set-up

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

Speak no evil!

Medications Analgesics Sedatives Anxiolytics Sedative-hypnotics Dissociative anesthetic Anesthetics

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

Sedatives/Anxiolytics Benzodiazepines –Versed –Great safety profile Barbiturates –Pentobarbital

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

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

Propofol Quick onset and offset Antiemetic properties Side effects Consider capnography

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

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

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

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

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