Procedural Sedation for Infants, Children, and Adolescents

305 Pages·2016·3.022 MB·English

by  Joseph D. Tobias, Joseph P. Cravero

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PSFICAA COVER SPREAD.indd 1 7/20/15 10:35 AM
Procedural Sedation for Infants, Children,
and A dolescents
Section on Anesthesiology and Pain Medicine
American Academy of Pediatrics
Editors
Joseph D. Tobias, MD, FAAP
Joseph P. Cravero, MD, FAAP
American Academy of Pediatrics
141 Northwest Point Blvd
Elk Grove Village, IL 60007-1019
American Academy of Pediatrics Publishing Staff
Director, Department of Publishing: Mark Grimes
Manager, Product Development: Eileen Glasstetter, MS
Manager, Publishing and Production Services: Theresa Wiener
Manager, Editorial Services: Jason Crase
Manager, Art Direction and Production: Linda Diamond
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Marketing Manager, Professional Publications: Linda Smessaert, MSIMC
Library of Congress Control Number: 2014957782
ISBN: 978-1-58110-933-7
eBook: 978-1-58110-934-4
The recommendations in this publication do not indicate an exclusive course of treatment or serve
as a standard of medical care. Variations, taking into account individual circumstances, may be
appropriate.
Every effort has been made to ensure that the drug selection and dosages set forth in this text are
in accordance with the current recommendations and practice at the time of publication. It is the
responsibility of the health care professional to check the package insert of each drug for any change
in indications and dosages and for added warnings and precautions.
Product names are mentioned in this publication for identification and informational purposes only
and do not imply endorsement by the American Academy of Pediatrics.
The American Academy of Pediatrics is not responsible for the content of the resources mentioned
in this publication. Web site addresses are as current as possible but may change at any time.
The publishers have made every effort to trace the copyright holders for borrowed materials. If they
have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the
first opportunity.
Disclosures: Dr Zempsky indicated an advisory board relationship with Marathon Pharmaceuticals
and Vapogenix. Dr Berkenbosch conducts clinical trials sponsored by Grünenthal Group and Janssen
Pharmaceuticals with no personal compensation to him. All other contributors disclosed no relevant
financial relationships.
This book has been developed by the American Academy of Pediatrics. The authors, editors, and
contributors are expert authorities in the field of pediatrics. No commercial involvement of any kind
has been solicited or accepted in the development of the content of this publication.
Copyright © 2016 American Academy of Pediatrics. All rights reserved. No part of this p ublication
may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—
electronic, mechanical, photocopying, recording, or otherwise—without prior permission from
the publisher (locate title at http://ebooks.aappublications.org; click on © Get Permissions).
Printed in the United States of America.
MA0753
9-350/0815 1 2 3 4 5 6 7 8 9 10
American Academy of Pediatrics
Section on Anesthesiology and Pain Medicine
2014–2015
Executive Committee Members
Joseph D. Tobias, MD, FAAP, Chairperson
Rita Agarwal, MD, FAAP, Chairperson-Elect
Corrie T. M. Anderson, MD, FAAP
Courtney A. Hardy, MD, FAAP
Anita Honkanen, MD, FAAP
Mohamed A. Rehman, MD, FAAP
Carolyn F. Bannister, MD, FAAP, Immediate Past Chairperson
Liaisons
Randall P. Flick, MD, MPH, FAAP, American Society of Anesthesiologists
Committee on Pediatric Anesthesia
Constance S. Houck, MD, FAAP, American Academy of Pediatrics
Committee on Drugs
Staff
Jennifer Riefe, MEd
Contributors/Reviewers
Editors
Joseph D. Tobias, MD, FAAP Joseph P. Cravero, MD, FAAP
Chief, Department of Anesthesiology and Associate Professor of Anaesthesia
Pain Medicine Harvard Medical School
Nationwide Children’s Hospital Senior Associate, Divisions of Perioperative
Professor of Anesthesiology and Pediatrics Anesthesia and Pain Medicine
The Ohio State University Boston Children’s Hospital
Columbus, OH Boston, MA
Chapter Authors
John W. Berkenbosch, MD, FCCM, FAAP Joanne R. Hojsak, MD
Professor of Pediatrics and Pediatric Critical Associate Professor
Care Department of Pediatrics, Pediatric Critical
Director, University Children’s Sedation Service Care Medicine
University of Louisville Icahn School of Medicine at Mount Sinai
Kosair Children’s Hospital Kravis Children’s Hospital at Mount Sinai
Louisville, KY New York, NY
5: Medications Part 1: Sedatives and Anxiolytics 8: Specific Clinical Scenarios
Joseph P. Cravero, MD, FAAP Gregory A. Hollman, MD, FAAP
Associate Professor of Anaesthesia Professor of Pediatrics
Harvard Medical School Division of Pediatric Critical Care Medicine
Senior Associate, Divisions of Perioperative Medical Director, Diagnostic and
Anesthesia and Pain Medicine Therapy Center
Boston Children’s Hospital University of Wisconsin
Boston, MA American Family Children’s Hospital
1: Pediatric Sedation: The Past, Present, Madison, WI
and Future 9: Non-pharmacologic Interventions in
7: Complications of Procedural Sedation Children During Medical and Surgical
Procedures
Eric W. Fleegler, MD, MPH, FAAP
11: Pediatric Sedation Credentialing and
Assistant Professor of Pediatrics
Privileging
Harvard Medical School
Division of Emergency Medicine Constance S. Houck, MD, FAAP
Boston Children’s Hospital Associate Professor of Anaesthesia
Boston, MA Harvard Medical School
4: Monitoring for Procedural Sedation Senior Associate, Division of Perioperative
Anesthesia
Cheryl K. Gooden, MD, FAAP
Boston Children’s Hospital
Associate Professor of Anesthesiology
Boston, MA
and Pediatrics
4: Monitoring for Procedural Sedation
Icahn School of Medicine at Mount Sinai
10: Topical and Local Anesthetic Agents
Kravis Children’s Hospital at Mount Sinai
New York, NY Pradip P. Kamat, MD, MBA, FAAP
8: Specific Clinical Scenarios Director, Children’s Sedation Services
Children’s at Egelston
Assistant Professor of Pediatrics
Emory University
Atlanta, GA
7: Complications of Procedural Sedation
Contributors/Reviewers v
Marc S. Leder, MD, FAAP Thomas A. Taghon, DO, MHA
Attending Physician, Department of Vice Chair, Quality Improvement
Emergency Medicine Department of Anesthesiology and Pain
Nationwide Children’s Hospital Medicine
Clinical Professor of Pediatrics Nationwide Children’s Hospital
The Ohio State University Clinical Assistant Professor of Anesthesiology
Columbus, OH The Ohio State University
6: Medications Part 2: Ketamine, Nitrous Oxide, Columbus, OH
and Opioids 12: Quality Improvement and Assurance
Kristine K. Murray, CCLS Joseph D. Tobias, MD, FAAP
Child Life Specialist, Diagnostic and Chief, Department of Anesthesiology and
Therapy Center Pain Medicine
University of Wisconsin Nationwide Children’s Hospital
American Family Children’s Hospital Professor of Anesthesiology and Pediatrics
Madison, WI The Ohio State University
9: Non-pharmacologic Interventions in Columbus, OH
Children During Medical and Surgical 2: The Pre-sedation Evaluation
Procedures 6: Medications Part 2: Ketamine, Nitrous Oxide,
and Opioids
Daniel M. Roke, MD, FAAP
10: Topical and Local Anesthetic Agents
Assistant Professor
Division of Pediatric Anesthesiology Joshua C. Uffman, MD
Vanderbilt University Director, Procedural Sedation and Off-Site
Medical Director, PATCH Clinic Anesthesia
Monroe Carell Jr Children’s Hospital at Department of Anesthesiology and Pain
Vanderbilt Medicine
Nashville, TN Nationwide Children’s Hospital
3: Documentation and Parental Instructions Clinical Assistant Professor of Anesthesiology
for Pediatric Sedation The Ohio State University
Columbus, OH
Sandra P. Spencer, MD, FAAP
12: Quality Improvement and Assurance
Attending Physician, Department of
Emergency Medicine William T. Zempsky, MD, MPH, FAAP
Nationwide Children’s Hospital Chief, Division of Pain and Palliative Medicine
Assistant Professor of Clinical Pediatrics Connecticut Children’s Medical Center
The Ohio State University Professor of Pediatrics
Columbus, OH University of Connecticut School of Medicine
6: Medications Part 2: Ketamine, Nitrous Oxide, Hartford, CT
and Opioids 10: Topical and Local Anesthetic Agents
Michael J. Stoner, MD, FAAP
Attending Physician, Department of
Emergency Medicine
Nationwide Children’s Hospital
Assistant Professor of Clinical Pediatrics
The Ohio State University
Columbus, OH
6: Medications Part 2: Ketamine, Nitrous Oxide,
and Opioids
vi Contributors/Reviewers
American Academy of Pediatrics Reviewers
Board of Directors Reviewer
Anthony D. Johnson, MD, FAAP
Committees, Councils, and Sections
Committee on Drugs Section on Cardiology and Cardiac Surgery
Committee on Medical Liability and Risk Section on Emergency Medicine
Management Section on Gastroenterology, Hepatology, and
Committee on Pediatric Emergency Medicine Nutrition
Committee on Substance Abuse Section on Hematology/Oncology
Council on Quality Improvement and Section on Oral Health
Patient Safety
To those who care for and comfort children.
You hold my hand, your pace is slow.
You give me time for my stride to grow.
I follow you and learn your ways.
You teach me how to walk my days.
Your steps are big, mine are small.
We stroll together, through it all.
Take my hand, don’t let go.
But hold it loose, to let me grow.
—Anonymous
To my wife, Julie, and my boys, Drew and Michael, who inspire, guide,
and love me unconditionally; buddies forever.
—Joseph D. Tobias, MD, FAAP
To my family—who have taught me everything I know about love
and humanity, in all aspects of life.
—Joseph P. Cravero, MD, FAAP
Contents
Foreword ............................................................................................................xi
Charles J. Coté, MD, FAAP
Preface.............................................................................................................xiii
Joseph D. Tobias, MD, FAAP
Joseph P. Cravero, MD, FAAP
Chapter 1 Pediatric Sedation: The Past, Present, and Future ...........................1
Joseph P. Cravero, MD, FAAP
Chapter 2 The Pre-sedation Evaluation ...........................................................11
Joseph D. Tobias, MD, FAAP
Chapter 3 Documentation and Parental Instructions for
Pediatric Sedation .........................................................................27
Daniel M. Roke, MD, FAAP
Chapter 4 Monitoring for Procedural Sedation .............................................43
Eric W. Fleegler, MD, MPH, FAAP
Constance S. Houck, MD, FAAP
Chapter 5 Medications Part 1: Sedatives and Anxiolytics ...............................61
John W. Berkenbosch, MD, FCCM, FAAP
Chapter 6 Medications Part 2: Ketamine, Nitrous Oxide, and Opioids ............91
Marc S. Leder, MD, FAAP
Sandra P. Spencer, MD, FAAP
Joseph D. Tobias, MD, FAAP
Michael J. Stoner, MD, FAAP
Chapter 7 Complications of Procedural Sedation...........................................115
Joseph P. Cravero, MD, FAAP
Pradip P. Kamat, MD, MBA, FAAP
Chapter 8 Specific Clinical Scenarios ...........................................................137
Cheryl K. Gooden, MD, FAAP
Joanne R. Hojsak, MD
Chapter 9 Non-pharmacologic Interventions in Children During
Medical and Surgical Procedures ..................................................177
Kristine K. Murray, CCLS
Gregory A. Hollman, MD, FAAP
x Contents
Chapter 10 Topical and Local Anesthetic Agents ...........................................205
Constance S. Houck, MD, FAAP
William T. Zempsky, MD, MPH, FAAP
Joseph D. Tobias, MD, FAAP
Chapter 11 Pediatric Sedation Credentialing and Privileging ........................225
Gregory A. Hollman, MD, FAAP
Chapter 12 Quality Improvement and Assurance ...........................................253
Thomas A. Taghon, DO, MHA
Joshua C. Uffman, MD
Index ...............................................................................................................285