• Paediatric sedation 2
    • Definition of sedation
      • State of sleep or drowsiness from which the subject can be roused
    • Contraindications to sedation by non-anesthetists
      • Abnormal airway
      • Raised ICP
      • Depressed conscious level
      • OSAS
      • Respiratory failure
      • Neuromuscular disease
      • Bowel obstruction
      • Active URTI
      • Known allergy
      • Child too distressed despite adequate preparation
      • Older children with behavioural problem
      • Consent refusal by parent or patient
    • Common procedures and requirements
      • Painless procedures
        • TTE
          • Midazolam 20-50μcg/kg IV
        • CT
          • Midazolam
        • MRI
          • Infants may sleep
          • Children may need anaesthesia
        • Radiotherapy
          • Sedation or anaesthesia
        • EEG
          • Natural sleep preferred
      • Painful procedures
        • Oncology procedures (LP, IT injections, bone marrow aspiration)
          • Anaesthesia
        • Interventional neuro
          • Anaesthesia
        • Cardiac angiography
          • Anaesthesia
        • Oesophagogastroscopy colonoscopy
          • Anaesthesia
        • Dental procedures
          • Anaesthesia or sedation
          • Basic/standard sedation
            • Nitrous oxide 70% via nasal mask
            • IV midazolam titrated at 25-50μcg/kg
          • Advanced/alternative sedation
            • Used combinations of midazolam, fentanyl, nitrous oxide and sevoflurane
        • Wound care
          • Sedation or anaesthesia
          • Nitrous oxide or oral midazolam 0.5mg/kg
          • Fentanyl 0.25-0.5μcg/kg
          • Ketamine 2mg/kg IV or 5-10mg/kg IM
    • Drugs used for sedation
      • Chloral hydrate
        • Useful gastric sedation
        • 100mg/kg (max dose 1g)
        • Some deaths have occurred
      • Barbituates
        • Thiopentone
          • Can be used rectally 25-50mg/kg
      • Propofol
        • Not used by non anaesthetists
      • Melatonin
        • 2-10mg orally works in 55% for MRI
      • Major tranquilisers
        • Trimeprazine
        • Chlorpromazine
      • Benzodiazepines
        • Midazolam
          • Oral 0.5mg/kg
          • Nasal 0.2mg/kg
          • IV 0.05-0.2mg/kg
        • Temazepam
          • Oral 0.5-1mg/kg
          • Can add in 0.25mg/kg droperidol to improve efficacy
        • Reversal with 20-30μcg/kg IV flumazenil
      • Opioids
        • Can cause relaxation
        • Morphine
          • 60μcg/kg
        • Fentanyl
          • 1-6μcg/kg
        • Reversal with 10μcg/kg naloxone
      • Nitrous oxide
      • Ketamine
        • Oral 6mg/kg
        • IM 2-10mg/kg
    • Problems with drugs
      • Anaesthetic drugs have too small differences between sedative doses and anaesthetic doses
      • Safe drugs are often not potent enough and may not always succeed
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/4/4/118.full.pdf?sid=c0725058-6829-41ab-b704-0957fe916928