Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation For Diagnostic and Therapeutic Procedures

In the last 5 years there has been an increase in invasive diagnostic, radiologic, and minor surgical procedures on pediatric patients outside the traditional operating room setting. As a consequence, there has been a marked increase in the use of sedatives and general anesthetic agents in physician offices, dental offices, subspecialty procedure suites, imaging facilities, emergency departments, and ambulatory surgery centers.1-17 In recognition of the expanding need for both the elective and emergency use of these agents in nontraditional settings, the American Academy of Pediatrics guidelines for the use of depressant agents in children, first presented in 1985 under the title "Guidelines for the Elective Use of Conscious Sedation, Deep Sedation, and General Anesthesia in Pediatric Patients,"18 have been revised. This revised statement reflects our current understanding of appropriate monitoring needs, both during and after a procedure, for children receiving sedatives and general anesthetic agents.19-29 The monitoring and care outlined in these guidelines may be exceeded at any time, based on the judgment of the responsible physician. Although they are intended to encourage high-quality patient care, observing these guidelines cannot guarantee a specific patient outcome. They are subject to revision from time to time, as warranted by the evolution of technology and practice. These guidelines are proffered with the awareness that regardless of the intended level of sedation or route of administration, the sedation of a patient represents a continuum, and may result in the loss of the patient's protective reflexes;30 a patient may move easily from a light level of sedation to obtundation.1-6,8,12,14,15,26,29