Sedation in Pediatric Imaging

Pre-sedation Assessment - Prepping for Peace

• Goal: Ensure patient safety & successful sedation for imaging.
• Key Steps:
  • History: Medical, surgical, anaesthetic history; allergies; medications; NPO status (last oral intake).
  • Examination: Airway (e.g., Mallampati, neck mobility), CVS, RS, CNS. Assign ASA physical status.
  • NPO Guidelines: Adherence critical. 📌 "2-4-6-8 Rule" as quick recall.

    ⭐ Current NPO: Clear liquids ≥2h, breast milk ≥4h, infant formula/non-human milk/light meal ≥6h, solids/fried/fatty meal ≥8h before elective procedures.

  • Consent: Informed, written consent obtained.
  • Investigations: Usually not indicated for healthy children (ASA I or II).

Pharmacological Agents - Potions & Protocols

Selection guided by procedure, patient status, and available expertise. Always ensure availability of resuscitation equipment and reversal agents.

• Titrate to effect for desired sedation level.
• Continuous monitoring of vitals (HR, RR, SpO2, BP) is mandatory.
• Strict adherence to NPO guidelines is crucial.

Intra-sedation Monitoring - Guardian Duty

• Core Monitoring (Continuous):
  • Pulse oximetry (SpO2 > 94%, alarm < 90%).
  • Heart rate, rhythm.
  • Respiratory rate, pattern, effort.
  • Capnography (ETCO2): detects hypoventilation.
  • Blood pressure (NIBP q5min).
  • Level of consciousness.
• Essential Equipment:
  • Oxygen source, delivery systems.
  • Bag-Valve-Mask (BVM), suction.
  • Airway adjuncts (OPA, NPA).
  • Reversal agents, resuscitation drugs.
• Personnel: Dedicated trained individual (PALS certified) for monitoring.

⭐ Capnography is the most sensitive indicator of early respiratory depression, apnea, and airway obstruction.

Complications & Discharge - Crisis Control

• Complications:
  • Respiratory: Hypoventilation, apnea, laryngospasm, desaturation (O₂↓).
  • Cardiovascular: Hypotension, bradycardia, arrhythmias.
  • GI: Vomiting (aspiration risk).
  • CNS: Paradoxical agitation, prolonged sedation.
• Crisis Control (ABCs):
  • Airway: Maneuvers, O₂, suction.
  • Breathing: BMV, supplemental O₂, consider reversal.
  • Circulation: IV fluids, vasopressors.
• Discharge (Aldrete Score ≥9):
  • Vitals stable & age-appropriate (HR, RR, BP, SpO₂).
  • Awake, alert, baseline neuro status.
  • Tolerates oral intake.
  • Responsible escort present.

⭐ Reversal Doses:

• Flumazenil (Benzos): 0.01 mg/kg IV (max 0.2 mg/dose; total 1 mg).
• Naloxone (Opioids): 0.01 mg/kg IV (<5y/<20kg); 0.1 mg/kg IV (>5y/>20kg). Max 2mg/dose.

High‑Yield Points - ⚡ Biggest Takeaways

• Strict NPO guidelines (e.g., 2 hrs clear liquids, 6 hrs solids) are vital to prevent aspiration.
• Dexmedetomidine is preferred for procedural sedation due to its favorable safety profile and arousable sedation.
• Midazolam (intranasal/oral) is effective for anxiolysis pre-procedure.
• Comprehensive monitoring (pulse oximetry, capnography, vitals) is mandatory throughout.
• Always ensure availability of reversal agents (flumazenil, naloxone) and emergency equipment.
• Pre-sedation risk assessment using ASA status is crucial for patient safety.