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This database has provided vital information to define the frequency and nature of adverse events during pediatric sedation from a multispecialty perspective .
The American Academy of Pediatrics, Section on Anesthesiology has published Guidelines for the Pediatric Perioperative Anesthesia Environment, which includes suggestions for age categorization, need for intensive care following sedation for recovery, and presence of coexisting disease .
Since these guidelines were published, sedation outside of the operating room continues to increase, along with the varied practitioner’s disciplines that are delivering sedation.
Sedation and analgesia for the pediatric patient with developmental disabilities and neurologic disorder require a thorough understanding of potential adverse events, and the knowledge and skill to avoid potentially life-threatening complications from the administration of sedative and analgesic medications.
In addition, the practitioner must focus particular attention on the entire periprocedural period including presedation evaluation, sedation/analgesia administration, and recovery.
However, the patients classified as having developmental disability had a threefold increased incidence of hypoxia (11.9% versus 4.9%; ).
These findings seem to recapitulate the findings described in the PSRC studies: an increase in adverse events, most notably airway compromise, for children with developmental disabilities and those with neurologic disorders.
In subsequent analysis, factors that related to higher rates of pulmonary complications were young patients, use of adjunctive opiates, and patients with a higher American Society of Anesthesiology (ASA) status (≥III), a large proportion with neurologic conditions .
This continues to emphasize that pediatric patients with neurologic disorder and developmental disabilities receiving sedation continue to be at increased risk for adverse events with the most prevalent concerns for airway obstruction and altered respiratory mechanics.
Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA 19129, USAReceived 2 December 2009; Revised 15 June 2010; Accepted 20 June 2010Academic Editor: Savithiri Ratnapalan Copyright © 2010 Todd J. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sedation and analgesia performed by the pediatrician and pediatric subspecialists are becoming increasingly common for diagnostic and therapeutic purposes in children with developmental disabilities and neurologic disorders (autism, epilepsy, stroke, obstructive hydrocephalus, traumatic brain injury, intracranial hemorrhage, and hypoxic-ischemic encephalopathy).
Pediatricians and pediatric subspecialists are increasing being called upon to safely sedate and provide analgesia for these children for diagnostic procedures (CT, MRI, angiogram, endoscopy, and bronchoscopy) and for therapeutic interventions (interventional radiology, intracranial injury, and emergency stabilization).