Indications for sedating infants and children in the emergency department include diagnostic procedures (CT scans) and as an adjunct to analgesia and anesthesia for painful procedures.9 Table 130-14. lists common pharmacologic options for sedation. Nonpharmacologic techniques should also be considered when preparing to sedate children and should not be forgotten in the midst of a busy emergency department. As previously discussed, parental involvement, verbal preparation, relaxation, tactile stimulation, and distraction techniques are all effective. Manual restraint (sheets or papoose boards) may be required as an adjunct to the nonpharmacologic and pharmacologic approach to procedures for infants and toddlers. Parent should not be requested to provide or be responsible for the restraint of the child, but rather should be encouraged to provide comfort.
TABLE 130-14 Sedative Drugs for the Pediatric Patient
An ideal pharmacologic agent for sedation is one that is effective, has rapid onset, is easily titratable with a predictable duration of action, is quickly eliminated or reversible, has no adverse effects, and is easy and painless to administer. Although the ideal agent does not exist, there are several good drugs and regimens that when administered appropriately can provide safe and adequate analgesia and/or anesthesia.
Sedatives can be administered by a variety of routes including IV, IM, oral, rectal, sublingual, transmucosal, and intranasal; each route has advantages and disadvantages. Intravenous administration allows the most precise titration of drug to the desired effect; IM administration usually is painful and not titratable. Oral and transmucosal routes are more readily accepted by children than nasal or rectal routes. Despite the options for administration routes, side effects can occur with any route of administration.
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