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Sedation of Children for Technical Procedures

Current Standard of Practice

Department of Pediatrics, Tripler Army Medical Center Honolulu, Hawaii

James W. Bass, M.D.

Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hl 96859-5000

Simone Nomizu, M.D.

Department of Pediatrics, Tripler Army Medical Center Honolulu, Hawaii

Mark E. Alexander, M.D.

Department of Pediatrics, Tripler Army Medical Center Honolulu, Hawaii

We sought to define the current standard of care for children undergoing sedation for painless diagnostic procedures by sending questionnaires to 284 pediatric residency program directors in North America. From the 89 responses, we determined that departments of pediatrics set sedation policies for children in most institutions, often with formal written guidelines for these procedures. Most require that children have some form of cardiorespiratory monitoring while under sedation and that they are attended by individuals trained in cardiorespiratory resuscitation until the child is fully recovered. The use of parents to transport and monitor the sedated child is uncommon, and total lack of monitoring is rare. Chloral hydrate in dosages of 25 mg/kg to 100 mg/kg is the most common drug used for sedation; DPT, a combination of parenteral Demerol(meperidine), Phenergan (promethazine), and Thorazine (chlorpromazine), at a maximum dose of 2 mg/lmg/lmg/kg is the second; and pentobarbital in a dosage of 5 mg/kg to 7 mg/kg is the third. These sedation regimens were associated with few serious side effects, except that two deaths were reported in infants with congenital heart disease who were sedated with DPT. We believe this survey may reflect the current standard of practice for sedation in North American infants and children undergoing diagnostic procedures.

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