Post on 23-Dec-2015
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.
It’s all about the “P’s” and an “A”
• Provider preparation
• Patient preparation
• Pain control and adequate sedation
• Anticipation
• Post procedure care
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
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
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
Combos
• Versed/fentanyl
• Versed/morphine
• Ketamine/atropine/versed
• Etomidate/fentanyl
• “Ketofol”
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