Skip to main content
Log in

Sedation in pediatric patients

  • Special Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Sedation is being used increasingly in children to allay anxiety and discomfort. Sedation can also increase the efficiency of performing both diagnostic and therapeutic procedures in children. There are a wide array of available sedation methods that are used by radiologists, gastroenterologists, hematologists/oncologists and emergency room physicians everyday. Indiscriminate use of sedatives has led to seizures, respiratory arrests and death in a variety of practice settings. With improved monitoring capability, more potent drugs and better understanding of the pharmacokinetics in children, it is possible to provide batter care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cote CJ. Sedation for the pediatric patient: A Review.Pediatric Clinics of North America. 1994; 41:31–58.

    PubMed  CAS  Google Scholar 

  2. Committee on Drugs, American Academy of Pediatrics. Guideline for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures.Pediatrics 1992; 89:1110–1115.

    Google Scholar 

  3. American Society of Anesthesiologists: Standards for basic intraoperative monitoring. American Society of Anesthesiology, Park Ridge, IL, 1990.

    Google Scholar 

  4. Krippaehne JA, Montgomery MT. Morbidity and mortality from pharmacosedation and general anesthesia in the dental office. J Oral Maxillofac Surg 1992; 50: 691–698.

    Article  PubMed  CAS  Google Scholar 

  5. Jastak JT, Peskin RM: Major morbidity or mortality from office anesthtic procedures: A closed claims analysis of 13 cases.Anesth Prog 1991; 38:39–44.

    PubMed  CAS  Google Scholar 

  6. Iber FL, Livak A, Kruss DM: Apnea and cardiopulmonary arrest during and after endoscopy.J Clin Gastroenterol 1992; 14: 109–113.

    Article  PubMed  CAS  Google Scholar 

  7. Moore PA, Mickey EA, hargreaves JAet al. Sedation in pediatric dentistry, a practical assessment procedure.JADA 1984; 109:564–569.

    PubMed  CAS  Google Scholar 

  8. McClay R: Asleep on the job: Sedation and monitoring during endoscopy.Scan J Gastroenterol Suppl 1992; 192: 97–101.

    Article  Google Scholar 

  9. Hubbard AM, Markowitz RI, Kimmel Bet al. Sedation for the pediatric patients undergoing CT and MRI.J comput Assist Tomogr 1992; 16:3–6.

    Article  PubMed  CAS  Google Scholar 

  10. Nelson MD Jr. Guidelines for monitoring and care of children during and after sedation for imaging studies.AJR 1993; 160:581–582.

    PubMed  Google Scholar 

  11. Splinter WM, Schaffer JD, Zunder IH. Clear fluids three hours before surgery do not affect the gastric fluid contents of children.Can J Anesth 1990; 37:498–501.

    PubMed  CAS  Google Scholar 

  12. Schreiner MS, Triebwasser A, Keon TP. Ingestion of liquids compared with preoperative fasting in pediatric outpatients.Anesthesiology 1990; 72:593–59.

    Article  PubMed  CAS  Google Scholar 

  13. Cote’ CJ. NPO after midnight for children: A reappraisal.Anesthesiology 1990; 72: 589–592.

    CAS  Google Scholar 

  14. Phillips S, Daborn AK, Hatch DJ. Preoperative fasting for pediatric anaesthesia.Br J Anesth 1994; 73:529–536.

    Article  CAS  Google Scholar 

  15. Kallar SK, Everett LL. Potential risks and preventive measures for pulmonary aspiration: New concepts in preoperative fasting guidelines.Anesth Anal 1993; 77: 171–182.

    Article  CAS  Google Scholar 

  16. Bricker SRW, McLuckie A, Nightingale DA. Gastric aspirates after trauma in children.Anaesthesia 1989; 44:721–724.

    Article  PubMed  CAS  Google Scholar 

  17. American Society of Anesthesiologists: Guidelines for non-operating room anesthetizing locations. American Society of Anesthesiologists, Park Ridge, IL. 1994.

    Google Scholar 

  18. Fleisher D. Monitoring the patient receiving conscious sedation for gastrointestinal endoscopy: Issues and guidelines. Gastrointestinal Endoscopy 1989; 35:262–266.

    Google Scholar 

  19. Rosenberg MB, Campbell RL. Guidelines for intraoperative monitoring for dental patients unergoind conscious sedation, and general anesthesia.Oral Surg Oral Med Oral Path 1991; 71:2–8.

    Article  PubMed  CAS  Google Scholar 

  20. Iwasaki J, Vann WF Jr, Dilley DCHet al. An investigation of capnography and pulse oximetry as monitors of pediatric patients sedated for dental treatment.Pediatr Dent 1989; 11:111–117.

    PubMed  CAS  Google Scholar 

  21. Dahlstrom B, Blome P, Feychting Het al. Morphine kinetics in children.Clin Pharmacol Ther 1979; 26:354–365.

    PubMed  CAS  Google Scholar 

  22. Lynn AM, Slattery JT. Morphine pharmacokinetics in early infancy.Anesthesiology. 1987; 66:136–139.

    Article  PubMed  CAS  Google Scholar 

  23. Album MM. Respiratory depression in a child following meperidine.ASDC J Dentistry Children 1979; 46:258–259.

    CAS  Google Scholar 

  24. Johnson KL, Erickson JP, Holley FOet al. Fentanyl pharmacokinetics in the pediatric population.Anesthesiology 1984; 61:A441.

    Article  Google Scholar 

  25. Stoeckel H, Hengstmann JH, Schuttler J. Pharmacokinetics of fentanyl as a possible explanation for recurrence of respiratory depression.Br J Anaesth 1979; 51:741–745.

    Article  PubMed  CAS  Google Scholar 

  26. Scamman FL. Fentanyl-O2-N2O rigidity and pulmonary compliance.Anesth Anal 1983; 62:332–334.

    Article  CAS  Google Scholar 

  27. Streisand JB, Stanley TH, Hague Bet al. Oral transmucosal fentanyl citrate premedication in children.Anesth Anal 1989; 69:28–34.

    Article  CAS  Google Scholar 

  28. Schecter NL, Weisman SJ, Rosenblum M, Bernstein B, Conard PL. The use of oral transmucosal fentanyl citrute for painful procedures in children. Pediatrics 1995; 95:335–339.

    Google Scholar 

  29. Jaillon, Gardin ME, Lecocq Bet al. Pharmacokinetics of nalbuphine in infants, yound healthy volunteers and elderly patients.Clin Pharmacol Ther 1989; 46:226–223.

    Article  PubMed  CAS  Google Scholar 

  30. Morselli PL, Principi N, Tognoni Get al. Diazepam elimination in premature and full term infants and children.J Perinat Med 1973; 1:133–141.

    Article  PubMed  CAS  Google Scholar 

  31. Mattila MAK, Ruoppi MK, Ahlstrom-Bengs Eet al. A pharmacokinetic study of midazolam in pediatric patients undergoing cardiac surgery.Br J Anaesth 1988; 61:302–307.

    Article  Google Scholar 

  32. Mandelli M, Tognoni G, Garattini S. Clinical pharmacokinetics of diazepam.Clin Pharmacokinetics 1978; 3:72–91.

    Article  CAS  Google Scholar 

  33. Saint-Maurice C, Landias A, Delleur MMet al. The use of midazolam in diagnostic and short surgical procedures in children.Anesthesiology 1986; 65:536–538.

    Article  PubMed  CAS  Google Scholar 

  34. Sandler ES, Weyman C, Conner Ket al. Midazolam vs Fentanyl as premedication for painful procedures in children with cancer.Pediatrics 1992; 89:631–634.

    PubMed  CAS  Google Scholar 

  35. Saint-Maurice C, Meistleman C, Rey Eet al. The pharmacokinetics of rectal midazolam for premedication in children.Anesthesiology 1986; 65:536–538.

    Article  PubMed  CAS  Google Scholar 

  36. Theroux MC, West DW, Corddry DHet al. Efficacy of intranasal midazolam in facilitating suturing of lacerations in perschool children in the emergency department.Pediatrics 1993; 91:624–627.

    PubMed  CAS  Google Scholar 

  37. Binder LS, Leake LA. Chloral Hydrate for emergent pediatric procedural sedation: A new look at an old drug.Am J Emerg Med 1991; 9:530–534.

    Article  PubMed  CAS  Google Scholar 

  38. Reimche LD, Sankaran K, Hindmarsh KWet al. Chloral hydrate sedation in neonates and infants: clinical and pharmacological considerations.Dev Pharm Ther 1989; 12:57–64.

    CAS  Google Scholar 

  39. Mayers DJ, Hindmarsh KW, Sankaran Ket al. Chloral hydrate disposition following single dose administration to critically ill neonates and children.Dev Pharmacol Ther 1991; 16:71–77.

    PubMed  CAS  Google Scholar 

  40. Meyers EF, Charles P. Prolonged adverse reactions to ketamine in children.Anesthesiology 1978; 49:39–40.

    Article  PubMed  CAS  Google Scholar 

  41. Takeshita H, Okuda Y, Sari A. The effects of ketamine on cerebral circulation and metabolism in man.Anesthesiology 1972; 36:69–75.

    Article  PubMed  CAS  Google Scholar 

  42. Pruitt JW, Goldwaser MS: Intramuscular ketamine, midazolam and glycopyrollate for pediatric sedation in the emergency room.J of Oral Maxilofascial Surgery 1995; 53 (1): 13–17.

    Article  CAS  Google Scholar 

  43. Louon A, Reddy VG: Nasal midazolam and ketamine for pediatric sedation during computerized tomography.Acta Anaesthesilogica Scand. 1994; 38 (3): 259–261.

    Article  CAS  Google Scholar 

  44. Alfonzo-Echeverri EC, Berg JH, Wild TW, Glass NL. Oral ketamine for pediatric outpatient dental sedation.Pedartic Dentisty 1993; 15 (3):182–185.

    CAS  Google Scholar 

  45. Griswold JD, Liu LMP. Rectal methohexiatl in children undergoing computerized cranial tomography and magnetic resonance imaging scans.Anesthesiology 1987; 67: A494.

    Article  Google Scholar 

  46. Terndrup TE, Cantor RM, Madden CM. Intramuscular meperidine, promethazine and chlorpromazine: Analysis of use in the current practice of pediatric anesthesia.Pediatric Anesthesia 1994; 4:79–82.

    Article  Google Scholar 

  47. Benusis KP, Kapaun D, Furnam LJ. Respiratory depression in a child following meperidine, proethazine and chlorpromazine premedication: Report of a case.J Dent Children 1979; 50–53.

  48. Smith I, White PF, Nathanson M, Gouldson R: Propofol: An update on its clinical use.Anesthesiology 1994; 81: 1005–1043.

    Article  PubMed  CAS  Google Scholar 

  49. Martin LD, Pasternak LR, Pudimat MA. Total intravenous anesthesia with propofol in pediatric patients outside the operating room.Anesth Anal 1992; 74: 609–612.

    CAS  Google Scholar 

  50. Frankville DD, Spear RM, Dyck JB. The dose of Propofol required to prevent children from moving during magnetic resonance imaging.Anesthesiology 1993; 79:953–958.

    Article  PubMed  CAS  Google Scholar 

  51. Bloomfield EL, Masaryk TJ, Caplin Aet al. Intravenous sedation for MR imaging of the brain and spine in children: Pentobarbital versus propofol.Pediatric radiology 1993; 186:93–97.

    CAS  Google Scholar 

  52. Haeflely W. The preclinical pharmacology of flumazenil.Eur J Anesthes. 1988; 2: 25–36.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Suresh, S., Hall, S.C. Sedation in pediatric patients. Indian J Pediatr 63, 13–22 (1996). https://doi.org/10.1007/BF02823860

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02823860

Key words

Navigation