Short Attention Span Summary
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Assess patients before sedation for any conditions that would put them at risk for sedation complications, such as serious chronic heart or lung disease. Look at the oropharynx for massive tonsils. Don’t deeply sedate kids unless you know how to manage an airway, have the right equipment, and have the right personnel. Fasting is always controversial. It should not be a concern if there is an emergent need to sedate. Don’t send them home until they return to near neurological baseline. That just saved you an hour!
Get full text of the guideline here.
Pediatrics. 2016 Jul;138(1). pii: e20161212. doi: 10.1542/peds.2016-1212.
The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication’s pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children.
Copyright © 2016 American Academy of Pediatric Dentistry and American Academy of Pediatrics. This report is being published concurrently in Pediatric Dentistry July 2016. The articles are identical. Either citation can be used when citing this report.
PMID: 27354454 [PubMed – in process]