University of Iowa Family Practice Handbook, Fourth Edition, Chapter 23

Reference Materials: Pediatric Sedation

Mark A. Graber, MD
Departments of Family Medicine and Emergency Medicine
University of Iowa College of Medicine
Peer Review Status: Externally Peer Reviewed by Mosby

1. Sedation can facilitate procedures in the ED and minimize the psychologic trauma to the child as well as to the ED staff and the parents.
2. Sedation requirements.
   1. Need good monitoring including 02 saturation, pulse, BP if possible, level of consciousness and respirations. The child should be closely monitored until he or she has returned to functional baseline value.
   2. Sedation does not equal pain relief. Give medications that relax the child and medications that provide pain relief.
   3. The traditional DPT (demerol, phenergan, and thorazine) or Kiddy Cocktail/Lytic Cocktail is fraught with problems and cannot be recommended.
   4. Benzodiazepines have the advantage of causing amnesia, especially midazolam.
   5. Despite drug company marketing, there is no significant difference in the recovery times of diazepam and midazolam when used as a single dose for sedation in the ED. In fact, the recovery time was faster with diazepam in most studies.
   6. Postsedation discharge requires a return to baseline verbal skills if appropriate, baseline muscular control, baseline mental status, and a parent or responsible person who can understand instructions.
3. Drugs for sedation and pain control in children are found in Table 23-1. Note: Sedative doses are for conscious sedation, which requires constant monitoring. Be familiar with these agents and their side effects before using!

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See related Provider Topics Brain and Nervous System, Pain or Symptoms and Manifestations.

See related Patient Topics Brain and Nervous System, Pain or Symptoms and Manifestations.

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