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Procedural Sedation

Procedural Sedation in Bhubaneshwar

Procedural sedation in paediatric patients centres on the administration of sedatives to minimise anxiety and pain associated with painful or unpleasant procedures. It is generally done by anaesthesiologists who are trained in paediatric sedation techniques and have a complete understanding of consent, administration, pharmacology of the drugs, and providing paediatric basic life support.

Paediatric patients who need critical care pose significant challenges to administering treatment, as they frequently experience stress or discomfort. Sedating the child enables medical professionals to keep them calm and pain-free when carrying out certain tests or complex procedures. At Manipal Hospitals in Bhubaneswar, Odisha, our skilled paediatric anesthesiologists offer procedural sedation to critical care children before undergoing a range of diagnostic and surgical procedures.

FAQ's

Sedation is administered to paediatric patients to manage pain, anxiety, and motion control. Indications that necessitate sedation include:

  • Diagnostic imaging, such as computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, nuclear medicine, interventional radiology, or contrast-enhanced voiding ultrasonography.

  • Diagnostic procedures, including Arthrocentesis, Biopsies, Lumbar Puncture, sexual assault examination, and other assessments.

  • Therapeutic procedures involve fracture or dislocation of bones or joints, laceration repair, insertion of a central venous catheter, draining of abscesses, hernia reduction, burn debridement, wound care, and other treatment interventions.

Yes. Procedural sedation is administered by skilled paediatric anaesthesiologists and confirms appropriate dosage calculations based on your child’s age, body weight, metabolism, and so on. Procedural sedation consists of generally three phases, which include minimal sedation, moderate sedation, and deep sedation.

  • In minimal sedation, small doses of drugs are administered and do not affect breathing. The child will be conscious during the procedure and will be able to respond to questions and commands.

  • In moderate sedation, patients are likely to fall asleep, although they can respond to commands with limitations.

  • In deep sedation, a high dose of one or more sedatives may be administered to your child. Your child may be able to respond to purposeful repeated or painful stimulation and is closely monitored to check if any airway complications are manifested.

Your child’s medical healthcare provider selects medications for sedating your child based on parameters such as age, weight, route of administration, level of sedation needed, and basic pharmacokinetics. Sedative drugs used commonly in paediatric patients include:

  • Opioids such as morphine, meperidine, and fentanyl

  • Benzodiapines such as diazepam, temaxepam, and midazolam. Newer drugs are under study to see if they contribute to expected outcomes with minimal risks, such as CNS 7056 and ADV6209.

  • Barbiturates, such as phenobarbital and methohexital

  • Major tranquillisers such as trimeprazine and a combination of chlorpromazine and promethazine

  • Other agents include nitrous oxide, ketamine, propofol, and dexmedetomidine

Yes, there are alternative treatments or techniques other than sedatives to calm your child, which include, but are not limited to:

  • MRI-compatible audio/visual system, which employs MRI-compatible headsets and screens to calm your child when they undergo an MRI scan.

  • Feed-sleep manipulation in infants involves feeding and swaddling babies, inducing natural sleep prior to an MRI scan.

  • Play therapy and role-playing can be done for young children before the examination of any procedure by explaining them in age-appropriate language and pretending to perform a procedure in a way they can understand.

  • Talking to a child psychologist or behavioural specialist facilitates providing children and parents with the necessary emotional support.

Certain risks or complications that could arise during procedural sedation are rare but present and may include irregular heart rhythm, breathing-related problems, mild nausea, headache, sore throat, changes in blood pressure, or allergic reactions when certain medicines are consumed. Scientists are investigating whether sedation or anaesthesia could impact the brain development of young children. Your child’s anesthesiologist or other specialists who are skilled in the domain will address the concern by providing timely intervention with various treatments.

Your child’s anaesthesiologist decides the administration of the drug based on the intent and type of procedure or treatment intervention, general condition, route of administration, risk-benefit ratio, and so forth. For less painful procedures, doctors usually administer intravenous pentobarbital or propofol. For indications such as wound healing, laceration repair, and other minimally invasive procedures, intranasal ketamine or a combination of intravenous fentanyl and midazolam is given. Painful procedures like bone marrow aspiration require midazolam, ketamine, or a combination of propofol and fentanyl given intravenously. Your child’s anesthesiologist will inform you of the type of sedative given to your child during the procedure.

Parameters such as the type and duration of the procedure, route of administration, and other factors influence your child’s recovery period. Your child will be transitioned to the recovery room post-procedure to wear off the sedative given. Children who had undergone minimally invasive procedures or received mild to moderate sedation doses were discharged promptly, whereas those who required deep sedation were kept in the recovery area for 2 hours or until they regained consciousness. Fluids are provided to the child one hour after they have become awake after a procedure or intervention. Your child’s specialist might ask you to delay physical activities or sports for 24 hours and seek medical assistance should any severe post-sedation symptoms, such as persistent dizziness and frequent vomiting, come up.

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