Monday, 4 July 2016

AAP/AAPD issue updated guidelines on safe sedation for children

AAP/AAPD issue updated guidelines on safe sedation for children The American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) have released updated guidelines on the monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. • The guidelines recommend that practitioners consult with appropriate subspecialists and/or an anesthesiologist for patients at increased risk of experiencing adverse sedation events because of their underlying medical/surgical conditions. • The child shall be accompanied by a parent, legal guardian, or other responsible person to and from the treatment facility. • Facilities, personnel, and equipment to manage emergency and rescue situations should be immediately available, including an emergency cart or kit containing the necessary age- and size-appropriate equipment (oral and nasal airways, bag-valve-mask device, LMAs or other supraglottic devices, laryngoscope blades, tracheal tubes, face masks, blood pressure cuffs, intravenous catheters, etc.) to resuscitate a nonbreathing and unconscious child. • The guidelines recommend documentation prior to sedation with regard to informed consent and instructions and information provided to the responsible person. • During the procedure, ventilation should preferably be monitored by capnography or by amplified, audible pretracheal stethoscope. • Not only the practitioner, but the support personnel should also be trained in and capable of providing advanced airway skills (e.g., PALS). A useful acronym ‘SOAPME’ is suggested as a checklist. S: Size-appropriate suction catheters and a functioning suction apparatus (eg, Yankauer-type suction) O: adequate Oxygen supply and functioning flow meters or other devices to allow its delivery A: size-appropriate Airway equipment (eg, bag-valve-mask or equivalent device [functioning]), nasopharyngeal and oropharyngeal airways, LMA, laryngoscope blades (checked and functioning), endotracheal tubes, stylets, face mask P: Pharmacy: all the basic drugs needed to support life during an emergency, including antagonists as indicated M: Monitors: functioning pulse oximeter with size-appropriate oximeter probes, end-tidal carbon dioxide monitor, and other monitors as appropriate for the procedure (eg, noninvasive blood pressure, ECG, stethoscope) E: special Equipment or drugs for a particular case (eg, defibrillator) The guidelines were published online June 27, 2016 and in the July issue of the journal Pediatrics

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