Medical procedures, even when painless, can be difficult for both your child and family. Sedation is the use of medicine to make a child more relaxed so he or she can better tolerate a procedure. It can also reduce pain and unpleasant memories. Unlike general anesthesia, during sedation your child still reacts to some stimuli and is able to breathe on his or her own.
Pediatric sedation is a valuable option that can help a child during a medical procedure, but no medical treatment is completely free of risk. To avoid these risks, doctors are careful about which patients they sedate. They also have a strong plan to ensure a safe and successful sedation.
When should my child be sedated?
While most children can undergo sedation for simple procedures, those with significant medical problems or undergoing particularly long or painful procedures may not be ideal for sedation. In these cases, your child might need general anesthesia. Also, some very brief, minimally painful procedures may not require sedation. Those procedures are best performed with topical anesthesia or with you or a child life specialist simply supporting your child during treatment.
Depending on the length of the procedure and the amount of pain expected, doctors can choose different levels of sedation. With minimal sedation the patient is awake and responds to verbal commands, but anxiety is well controlled. In moderate sedation, the patient is sleepy but responds to stimuli. With deep sedation the patient is asleep but can breathe on his or her own and can be woken up with stimuli. A single drug or a combination of medications will be used by your practitioner to achieve the appropriate level of sedation and a prompt recovery when the procedure is over.
What keeps my child safe during sedation?
Training. The resources your physician has for delivering a safe sedation are critical. Probably the most important thing is the doctor’s training. Anesthesiologists, but also some pediatric intensive care, emergency room and in-hospital care specialists, are qualified to deliver sedation to children. In addition, other health professionals like nurse anesthetists or pediatric dentists are frequently trained in pediatric sedation. Regardless of their healthcare background, all these professionals must have direct training in pediatric sedation and be certified in advanced life support. This means they are familiar with the routine events of sedation and have the expertise to control unexpected events or critical situations.
Equipment. Along with the solid training of your medical provider, equipment and resources are critical when performing a safe sedation. Make sure the procedure happens in a quiet, designated area, such as a procedure room, radiology suite or dental room. The space must be equipped with adequate oxygen and a cardiorespiratory monitor to track your child’s heart and breathing rhythms, oxygen concentration and exhaled carbon dioxide during and after sedation. There must also be equipment for life support and an established emergency rescue plan that includes personnel, equipment and immediate response by additional skilled professionals.
If any of these things are missing, you may need to seek other treatment options.
How do we prepare for sedation?
Before your child is sedated, he or she will not be allowed to eat for several hours. This can prove to be very challenging, particularly when the child is an infant or toddler who is already ill and desperately crying for food. Though frustrating to children and parents, this is an important medical precaution. Vomiting while your child is sedated can result in choking or lung damage that can seriously jeopardize his or her health.
You will be asked to sign a consent for your child to receive sedation. Use this opportunity to educate yourself and better understand the process of sedating a child. Remember that an informed patient is always a better patient. Meet the practitioner who will provide sedation to your child and ask questions like:
▪ Is my child a good candidate for sedation?
▪ What sedation plan will you use and what medications will he or she receive?
▪ Are you trained and certified in pediatric sedation and/or advanced support and how will my child be monitored while he or she is under sedation?
▪ Does your facility have the appropriate equipment and protocols to monitor my child while sedated and to address an emergency were it to happen?
▪ How and when will my child recover, and what precautions are needed after sedation?
When performed by a properly qualified professional with conscientious selection and planning, pediatric sedation will minimize your child’s pain and distress during many medical procedures. For more information about child sedation, visit http://www.pedsedation.org/wp-content/uploads/2013/09/FAQforParents.pdf.
Juan P. Solano, M.D., is a specialist in pediatric critical care medicine at UHealth – the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.