Sedation for pediatric patients outside the operating room: A review

ABSTRACT

Sedation is defined as "a technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation to render unintended loss of consciousness unlikely. In this sedated state, it is believed that protective reflexes are intact, the airway is maintained independently and continuously, and the child can respond to physical stimulation or verbal command. In reality and in pediatric practice, it is difficult to realize the anxiolysis, analgesia, sleep and lack of movement necessary for the safe conduct of many diagnostic and therapeutic procedures. Many children are in fact anesthetized to achieve these aims. Loss of consciousness is a state of anesthesia with all its attendant risks. In the published guidelines for pediatric sedation, definitions of light sedation, deep sedation and anesthesia overlap. It follows, therefore, that in the interests of safety, the standards for care for sedation should be the same as those for the child undergoing anesthesia. In dental practice, "conscious sedation" in tandem with behavioural management techniques is the ideal. If, despite the use of these techniques, the child remains uncooperative, alternative approaches such as deep sedation or general anesthesia are to be considered. This elusive state of "conscious sedation" is attempted in other areas outside the operating theatres in the belief that respiratory distress is less likely to occur. In many instances, the anesthesiologist is called when the procedure cannot be carried out because, either sedation is inadequate / unsuccessful or a complication of deep sedation has taken place. Barbiturates, benzodiazepines, narcotics, antihistaminics, chloral hydrate, ketamine, and propofol are among the drugs that have been used to induce sedation. Unfortunately, serious cardiac and respiratory side effects, as well as excessive sedation have been associated with these drugs, even when normal doses are used. This review shall endeavor to present the risk factors, agents and techniques, areas of application, and recommendations for the safe use of sedation.