AAP Issues New Guidelines on Pediatric Sedation
New guidelines on the safe sedation of children have been jointly issued by The American Academy of Pediatrics and the Academy of Pediatric Dentistry. The updated guidelines cover the monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures.
“The purpose of this updated report is to unify the guidelines for sedation used by medical and dental practitioners; to add clarifications regarding monitoring modalities, particularly regarding continuous expired carbon dioxide measurement; to provide updated information from the medical and dental literature; and to suggest methods for further improvement in safety and outcomes,” the guideline authors wrote.
A review of the literature elaborates on how practitioners should be mindful of the differences between adult sedation and pediatric sedation, which is often used to relieve pain and anxiety or to safely immobilize children for certain procedures. Some procedures can be accomplished with distraction, guided imagery techniques, local anesthetics, and, if necessary, minimal sedation. These and other techniques such as careful preparation, parental presence, hypnosis, and electronic devices with games or videos, may help to minimize the degree of sedation required.
When sedation is needed, research has indicated that children may often pass from the intended sedation level to an unintentional, deeper state. Thus, the concept of emergency management and rescue is vital for safe practice.
The guidelines state that practitioners of sedation must have the necessary facilities, personnel, and equipment available to rapidly respond to rescue situations, as well as a protocol in place for immediate back-up emergency services and to manage emergencies in the meantime. An appropriate level of training is recommended for the assistant to the clinician practicing sedation. The assistant responsible for constant observation of the child must now have a minimum of pediatric advanced life support training.
The guidelines also emphasize the components of appropriate documentation and consent, and they describe monitoring procedures in detail. Unlike previous guidelines, the new rules say that capnography is needed for children undergoing deep sedation and is highly encouraged for those undergoing moderate sedation.
Researchers published the updated guideline in the journal Pediatrics.
—Lauren LeBano
Reference
Coté CJ, Wilson S, American Academy of Pediatrics, American Academy of Pediatric Dentistry. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016. Pediatrics. 2016 June 27;[Epub ahead of print].