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Minerva Pediatrica 2009 April;61(2):193-215


language: English

Procedural sedation and analgesia in children by non-anesthesiologists in an Emergency Department

Leroy P. L. J. M. 1, 2, Gorzeman M. P. 2, 3, Sury M. R. J. 4, 5

1 Division of Pediatric Intensive Care Procedural sedation Unit Department of Pediatrics University Hospital Maastricht, The Netherlands 2 Dutch Guideline working group on Paediatric Procedural Sedation and Analgesia Dutch Institute for Health Care Improvement CBO Utrecht, The Netherlands 3 Department of Emergency Medicine Onze Lieve Vrouwe Gasthuis Amsterdam, The Netherlands 4 Department of Anesthesia Great Ormond Street Hospital for Children NHS Trust, London, UK 5 Portex Unit of Anesthesia Institute of Child Health University College London, London, UK


Procedural sedation and analgesia (PSA) is a standard of care for the management of acute procedural pain and anxiety in the emergency department (ED). However, there is evidence that PSA practice is still ineffective and potentially unsafe in many pediatric settings. PSA has to be regarded as a separate medical act that should be provided only by well-trained and credentialized professionals, within a context of transparency, registration and ongoing quality control. Only by maintaining strict criteria regarding professional competences, safety precautions, monitoring, recovery and rescue facilities an optimal patient safety can be guaranteed. Besides, ED professionals have a duty to deliver effective PSA, not only from a procedural point of view (i.e. guaranteeing predictable procedural success and timing) but also from a patient’s perspective (i.e. achieving optimal procedural comfort). An effective PSA program on a pediatric ED means that a professional is easily available at all times who is trained in the safe use of highly controllable drugs that match the sedation need and guarantee an optimal level of comfort — without the need for forced immobilization or restraint. A high-quality PSA service includes the adequate use of local or topical anesthesia, the systematic application of non-pharmacologic techniques, the availability of effective PSA drugs and the possibility of rescue anesthesia in case PSA is unsuccessful or is expected to be ineffective or unsafe in a given patient. PSA for children, including deep sedation, should be formally incorporated in the training program for emergency physicians.

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