Analgesic and procedural sedation principles unique to the pediatric emergency department

SCOPE OF THE PROBLEM Analgesia and sedation of infants, children, and adolescents occur on a daily basis in pediatric emergency departments (EDs) across the country. Some of the most important aspects of safely providing pain relief and/or analgesia for painful procedures or sedation/anxiolysis for nonpainful procedures in children are_an understanding of the definitions used for sedation of children_proper presedation assessment_methods of pain assessment_the presence of properly trained personnel and monitoring devices_age-appropriate equipment_postprocedure assessment and discharge instructions. The terminology commonly used includes those defined by the American Society of Anesthesiologists (ASA) for minimal sedation or anxiolysis, moderate sedation, deep sedation, and general anesthesia. An appropriate addition to this structure for the pediatric population is dissociative sedation, which is the trancelike state and analgesia induced by ketamine. This state allows for retention of protective airway reflexes and spontaneous respirations. There are numerous guidelines that exist for procedural sedation and analgesia (PSA) in children, including those developed for sedation by nonanesthesiologists by the American Society of Anesthesiologists and the American Academy of Pediatrics (AAP). The American College of Emergency Physicians has a clinical policy on procedural sedation and analgesia (PSA), as well as a policy on pharmacologic agents used in pediatric PSA. Since the Joint Commission on Accreditation of Healthcare Organization (JCAHO) developed standards for pain management and sedation, hospitals that are certified by this organization must adhere to these guidelines.