More children undergo medical and dental procedures that require sedation than in prior decades, prompting the American Academy of Pediatrics to update recommendations that provide a safety net for pediatric patients. The clinical report, “Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016,” will be published in the July 2016 Pediatrics (online June 27).
The AAP and the American Academy of Pediatric Dentistry collaborated to unify recommendations used by medical and dental practitioners and provide clarification and updates of prior reports. The report also includes a new requirement to monitor expired carbon dioxide to ensure airway patency and gas exchange. As a result, sedation monitoring is nearly identical to the requirements for general anesthesia. The sedation of children differs from adults, and is used to relieve pain and anxiety, as well as to modify behavior. The potential for a life-threatening event, such as apnea or airway obstruction, requires a sufficient number of people to carry out the procedure and monitor the patient. Studies have shown that it is common for children to pass from the intended level of sedation to a deeper, unintended level of sedation, according to the report. The report calls for a person in addition to the practitioner to monitor the patient and to assist in any supportive or resuscitation measures, if required. The monitoring and care outlined in the report may be exceeded at any time based on the practitioner’s judgment.