Our hospital has adopted procedural sedation as a standard protocol for young patients who are undergoing procedures that require the child to keep still. This practice is considered very safe. This excludes procedural sedation done in children’s emergency department.

What is Procedural Sedation Analgesia (PSA)?

In procedural sedation, medicines are used to sedate children who need to undergo short and/or painful hospital procedures. Some of these include:

• Bone marrow aspiration
• Cardiac scan
• Central line insertion
• Chest tube insertion
• Chest tube removal
• Diagnostic imaging scans such as CT scan, MRI scan and Nuclear Medicine study
• Electroencephalogram (EEG)
• Extensive dressing
• Lumbar Puncture (Spinal fluid aspiration)
• Skin biopsy
  

The sedative may be administered orally or through injection. In painful procedures, analgesic (painkillers) and/or local anaesthetic medications may also be prescribed. Your child will be monitored closely throughout the procedure.

Commonly used drugs are:

• Chloral Hydrate
• Ketamine
• Midazolam
• Fentanyl
• Morphine 
  

Are there any side effects?

Side effects of the medicines used for PSA include:

• Nausea and vomiting
• Rashes
• Diarrhoea
• Agitation or euphoria
• Respiratory depression
• Hypotension
  

Your child will be monitored closely during the procedure and prompt interventions will be instituted for side effects. Most side effects are self-limiting and usually resolve after one to two hours, or after treatment.

It is rare for the child to develop a bad allergic reaction to the medicines used in PSA. Appropriate and prompt treatment will be instituted if it occurs.

Is fasting required?

Yes. A minimum of THREE hours of fasting is necessary before administration of sedative, or as instructed by the doctor or nurse. MRI scan will require a fasting of 6 hours.

• Ensure that the last meal is light: plain milk (maximum one cup) with plain biscuits or plain bread (maximum two pieces).
• Heavy oily meals can cause child to vomit, potentially leading to food entering the lungs and causing life-threatening complications. This is because heavy oily meals tend to stay longer in the stomach and increase the risk of vomiting.

 
Who is not suitable for PSA?

• Patients with known allergy to the medicine used for PSA
• Patients who have taken a meal less than three hours before PSA
  

Who are at higher risk of PSA?

• Patients with an ongoing respiratory tract infection. Ideally, PSA should be administered after 2 weeks after recovery from the acute illness.
• Patients with unstable medical diseases.

However, the pros and cons of PSA will be discussed with you by your doctor depending on the urgency of the procedure.

What happens after PSA?

• Your child will be monitored closely in the ward until he/she regains full consciousness and is stable for 4-6 hours. Your child will be assessed by a doctor/nurse before discharge from sedation monitoring and commencing on any diet.

After returning from PSA, parents should:

• Supervise your child at all times for the next 4-6 hours after the procedure.

Useful information

As consent for procedural sedation is required, a parent/legal guardian should accompany the child for the procedure.