An Evidence-Based Guideline for the Pre-Operative Sedation of Children

There are numerous sedative pharmacological agents currently administered to children as premedicants to facilitate the induction of anaesthesia. When preoperative sedation is required, selection of the appropriate drug is imperative to provide adequate anxiolysis whilst minimising unwanted side effects. We review the literature regarding the merits and limitations of the commonly used agents and suggest evidence based practical guidance. For the anxious but cooperative child, oral midazolam is often adequate; however with more anxious younger and uncooperative children, combined oral midazolam and ketamine is more effective. Other oral benzodiazepines and oral clonidine all have their role when used in the appropriate circumstances. Intranasal clonidine is useful in the child refusing oral medication. Intramuscular ketamine should be reserved for extreme circumstances, administered only by anaesthetists experienced in its use, with full monitoring and resuscitative equipment immediately available.