Pediatric sedation guidelines emphasize that failure to rescue and inadequate airway management skills are the major contributory factors to adverse sedation events, highlighting the critical need for proper monitoring and systems-based safety protocols.
The American Academy of Pediatrics (AAP) became interested in sedation disasters in 1983 when three children died in a single dental office. The AAP asked the Section on Anesthesiology to help develop guidelines for monitoring children sedated by nonanaesthesiologists. I had the good fortune to co-author this first sedation guideline in 19851 Subsequently, the AAP recognised that the guideline was being ignored by general paediatric practitioners, particularly those in the emergency room, radiology, and other areas where sedation is widely used. Therefore, the guideline was revised in 1992 with a new title, and emphasis was placed on “systems issues”.2 A major source of confusion was the definition of “conscious sedation”, which was defined as “a purposeful response to either a painful stimulus or a verbal command.” Some practitioners interpreted reflex withdrawal to pain as being consistent with “conscious sedation”, and this led to a number of accidents. This term is contradictory to what really happens to children, and is misleading.3
CJ Coté (2010) conducted a review in Pediatric sedation. Pediatric sedation guidelines and practices was evaluated. Pediatric sedation guidelines emphasize that failure to rescue and inadequate airway management skills are the major contributory factors to adverse sedation events, highlighting the critical need for proper monitoring and systems-based safety protocols.
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