Pediatric Sedation Guidelines
Anesthesiology
- American Society of Anesthesiology (ASA) Standards, Guidelines and Statements https://www.asahq.org/standards-and-guidelines
- Williams MR, Nayshtut M, Hoefnagel A, et.al. Efficacy Outcome Measures for Pediatric Procedural Sedation Clinical Trials: An ACTTION Systematic Review. Anesth Analg. 2018 Mar;126(3):956-967. doi: 10.1213/ANE.0000000000002456. PMID: 28922236.
Pediatrics/Pediatric Hospital Medicine
- Coté CJ, Wilson S; American Academy of Pediatrics; American Academy of Pediatric Dentistry. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures. Pediatrics. 2019 Jun;143(6):e20191000. doi: 10.1542/peds.2019-1000. PMID: 31138666.
- Vercollone, L. W., Dela-Cruz, A., Archibald, T., et.al. (2016). Anesthesia Considerations for the Hospitalist. Hospital Medicine Clinics, 5(2), 281-302.
- Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology. 2018 Mar;128(3):437-479. doi: 10.1097/ALN.0000000000002043. PMID: 29334501.
- National Clinical Guideline Centre (UK). Sedation in children and young people: Evidence Update May 2012: A summary of selected new evidence relevant to NICE clinical guideline 112 ‘Sedation for diagnostic and therapeutic procedures in children and young people’ (2010) [Internet]. London: National Institute for Health and Clinical Excellence (NICE); 2012. PMID: 31886979.
- Bagley L, Kordun A, Sinnott S, et.al. Food allergy history and reaction to propofol administration in a large pediatric population. Paediatr Anaesth. 2021 May;31(5):570-577. doi: 10.1111/pan.14147. Epub 2021 Feb 18. PMID: 33529424.
- Kamat PP, McCracken CE, Simon HK, et.al. Trends in Outpatient Procedural Sedation: 2007-2018. Pediatrics. 2020 May;145(5):e20193559. doi: 10.1542/peds.2019-3559. PMID: 32332053.
Dentistry
- Coté CJ, Wilson S; American Academy of Pediatrics; American Academy of Pediatric Dentistry. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures. Pediatrics. 2019 Jun;143(6):e20191000. doi: 10.1542/peds.2019-1000. PMID: 31138666.
- Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology. 2018 Mar;128(3):437-479. doi: 10.1097/ALN.0000000000002043. PMID: 29334501.
- American Society of Anesthesiologists. Guidelines for Office-Based Anesthesia. (Developed By: Committee on Ambulatory Surgical Care; Last Amended: October 23, 2019 (original approval: October 13, 1999))
- Ashley P, Anand P, Andersson K. Best clinical practice guidance for conscious sedation of children undergoing dental treatment: an EAPD policy document. Eur Arch Paediatr Dent. 2021 Dec;22(6):989-1002. doi: 10.1007/s40368-021-00660-z. Epub 2021 Aug 28. PMID: 34453697; PMCID: PMC8629790.
- Wilson KE. Overview of Paediatric Dental Sedation: 1. current UK guidelines. Dent Update. 2013 Nov;40(9):728-30. doi: 10.12968/denu.2013.40.9.728. PMID: 24386764.
- American Academy of Pediatric Dentistry. Guideline on Use of Nitrous Oxide for Pediatric Dental Patients. Pediatr Dent. 2016 Oct;38(6):211-215. PMID: 27931462.
- American Academy of Pediatric Dentistry. Use of Anesthesia Providers in the Administration of Office-based Deep Sedation/General Anesthesia to the Pediatric Dental Patient. Pediatr Dent. 2018 Oct 15;40(6):317-320. PMID: 32074902.
- American Academy of Pediatric Dentistry. Guideline on Use of Local Anesthesia for Pediatric Dental Patients. Pediatr Dent. 2016 Oct;38(6):204-210. PMID: 27931461.
- American Academy of Pediatric Dentistry. Guideline on Informed Consent. Pediatr Dent. 2016 Oct;38(6):351-353. PMID: 27931476.
- American Dental Association. Guidelines for the use of sedation and general anesthesia by dentists. (Adopted by the ADA House of Delegates, October 2016)
- American Dental Association. Guidelines for Teaching Pediatric Pain Control and Sedation to Dentists and Dental Students. (Approved January 21, 2021).
- McIntosh B, Mierzwinski-Urban M. General Anesthesia and Deep Sedation for Dental Treatments in Children: A Review of Clinical Effectiveness and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017 Mar 6. PMID: 29298004.
- Scottish Dental Clinical Effectiveness Programme. Conscious sedation in dentistry: dental clinical guidance, 3rd ed. (June 2017).
Emergency Medicine
- Miller KA, Andolfatto G, Miner JR, et.al. Clinical Practice Guideline for Emergency Department Procedural Sedation With Propofol: 2018 Update. Ann Emerg Med. 2019 May;73(5):470-480. doi: 10.1016/j.annemergmed.2018.12.012. Epub 2019 Feb 4. PMID: 30732981.
- Wakai A, Blackburn C, McCabe A, et.al. The use of propofol for procedural sedation in emergency departments. Cochrane Database Syst Rev. 2015 Jul 29;2015(7):CD007399. doi: 10.1002/14651858.CD007399.pub2. PMID: 26222247; PMCID: PMC6517206.
- Iqbal AU, Shuster ME, Baum CR. Ketofol for Procedural Sedation and Analgesia in the Pediatric Population. Pediatr Emerg Care. 2022 Jan 1;38(1):28-33. doi: 10.1097/PEC.0000000000002599. PMID: 34986578.
- Green SM, Roback MG, Krauss BS, et.al. Unscheduled Procedural Sedation: A Multidisciplinary Consensus Practice Guideline. Ann Emerg Med. 2019 May;73(5):e51-e65. doi: 10.1016/j.annemergmed.2019.02.022. PMID: 31029297.
- Krmpotic K, Rieder MJ, Rosen D. Recommendations for procedural sedation in infants, children, and adolescents. Paediatr Child Health. 2021 Mar 16;26(2):128-129. doi: 10.1093/pch/pxaa139. PMID: 33747309; PMCID: PMC7962705.
- Green SM, Leroy PL, Roback MG, et.al; International Committee for the Advancement of Procedural Sedation. An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children. Anaesthesia. 2020 Mar;75(3):374-385. doi: 10.1111/anae.14892. Epub 2019 Dec 2. Erratum in: Anaesthesia. 2020 Jun;75(6):818. PMID: 31792941; PMCID: PMC7064977.
- Bhatt M, Johnson DW, Taljaard M, et.al; Sedation Safety Study Group of Pediatric Emergency Research Canada. Association of Preprocedural Fasting With Outcomes of Emergency Department Sedation in Children. JAMA Pediatr. 2018 Jul 1;172(7):678-685. doi: 10.1001/jamapediatrics.2018.0830. Erratum in: JAMA Pediatr. 2018 Aug 1;172(8):787. PMID: 29800944; PMCID: PMC6137504.
- Langhan ML, Shabanova V, Li FY, et.al. A randomized controlled trial of capnography during sedation in a pediatric emergency setting. Am J Emerg Med. 2015 Jan;33(1):25-30. doi: 10.1016/j.ajem.2014.09.050. Epub 2014 Oct 5. PMID: 25445871; PMCID: PMC4272647.
- Mace SE, Barata IA, Cravero JP, et.al; EMSC Grant Panel (Writing Committee) on Pharmacologic Agents Used in Pediatric Sedation and Analgesia in the Emergency Department; American Academy of Pediatrics; American Pediatric Surgical Association; Emergency Nurses Association. Clinical policy: evidence-based approach to pharmacologic agents used in pediatric sedation and analgesia in the emergency department. J Pediatr Surg. 2004 Oct;39(10):1472-84. doi: 10.1016/j.jpedsurg.2004.07.002. PMID: 15486890.
- Mace SE, Brown LA, Francis L, et.al; EMSC Panel (Writing Committee) on Critical Issues in the Sedation of Pediatric Patients in the Emergency. Clinical policy: Critical issues in the sedation of pediatric patients in the emergency department. Ann Emerg Med. 2008 Apr;51(4):378-99, 399.e1-57. doi: 10.1016/j.annemergmed.2007.11.001. PMID: 18359378.
Pediatric Intensive Care Unit
- Eidman DB, Clauss CL, Kelly SA, et.al. Dexmedetomidine for Sedation During Pediatric Noninvasive Ventilation. Respir Care. 2022 Mar;67(3):301-307. doi: 10.4187/respcare.09360. Epub 2022 Jan 25. PMID: 35078930.
Radiology
- American College of Radiology (ACR), Society of Interventional Radiology (SIR). ACR–SIR Practice Parameter for Minimal and/or Moderate Sedation/Analgesia. [online publication] American College of Radiology (ACR); 2020.
- The Royal College of Radiologists. Sedation, analgesia and anaesthesia in the radiology department, 2nd ed. (2018)
Gastroenterology
- ASGE Standards of Practice Committee, Early DS, Lightdale JR, Vargo JJ 2nd, et.al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2018 Feb;87(2):327-337. doi: 10.1016/j.gie.2017.07.018. Epub 2018 Jan 3. PMID: 29306520.
- Chung HK, Lightdale JR. Sedation and Monitoring in the Pediatric Patient during Gastrointestinal Endoscopy. Gastrointest Endosc Clin N Am. 2016 Jul;26(3):507-25. doi: 10.1016/j.giec.2016.02.004. PMID: 27372774.
- ASGE Standards of Practice Committee, Early DS, Lightdale JR, Vargo JJ 2nd, et.al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2018 Feb;87(2):327-337. doi: 10.1016/j.gie.2017.07.018. Epub 2018 Jan 3. PMID: 29306520.
- Goudra B, Singh PM. Critical Analysis of Guidelines for Providing Sedation to Patients Undergoing Gastrointestinal Endoscopy Procedures. Anesth Essays Res. 2019 Oct-Dec;13(4):601-607. doi: 10.4103/aer.AER_135_19. Epub 2019 Dec 16. PMID: 32009702; PMCID: PMC6937897.
- ASGE Standards of Practice Committee, Lightdale JR, Acosta R, Shergill AK, et.al; American Society for Gastrointestinal Endoscopy. Modifications in endoscopic practice for pediatric patients. Gastrointest Endosc. 2014 May;79(5):699-710. doi: 10.1016/j.gie.2013.08.014. Epub 2014 Mar 1. PMID: 24593951.
- Mason KP, Lightdale JL. Sedation for Pediatric Gastrointestinal Procedures. In: Pediatric sedation outside of the Operating Room: A Multispecialty International Collaboration. 3rd ed. Cham, Switzerland: Springer; 2021. p. 397–412.
- Dossa F, Megetto O, Yakubu M, et.al. Sedation practices for routine gastrointestinal endoscopy: a systematic review of recommendations. BMC Gastroenterol. 2021 Jan 7;21(1):22. doi: 10.1186/s12876-020-01561-z. PMID: 33413147; PMCID: PMC7792218.
- Stern J, Pozun A. Pediatric Procedural Sedation. 2021 Sep 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 34283466.
Nursing
- Society for Pediatric Sedation. Society for Pediatric Sedation® Nursing and Allied Health Committee. Pediatric Sedation Nursing Standards of Care (login required)
- Crego N. Procedural sedation practice: A review of current nursing standards. Journal of Nursing Regulation. 2015 Apr 1;6(1):50-6.
- Murphy JM. Credentialing process for nurse providers of moderate sedation. Journal of Radiology Nursing. 2013 Mar 1; 32(1):10-8.
- Wrona SK, Quinlan-Colwell A, Brown L, Jannuzzi RGE. Procedural Pain Management: Clinical Practice Recommendations American Society for Pain Management Nursing. Pain Manag Nurs. 2021 Dec 27:S1524-9042(21)00245-9. doi: 10.1016/j.pmn.2021.11.008. Epub ahead of print. PMID: 34969597.
- Proehl J, Arruda T, Crowley M, et.al. Emergency Nursing Resource: the use of capnography during procedural sedation/analgesia in the emergency department. J Emerg Nurs. 2011 Nov;37(6):533-6. doi: 10.1016/j.jen.2011.04.013. Epub 2011 May 19. PMID: 21600642.
- Lin OS, La Selva D, Kozarek RA, et.al. Nurse-Administered Propofol Continuous Infusion Sedation: A New Paradigm for Gastrointestinal Procedural Sedation. Am J Gastroenterol. 2021 Apr;116(4):710-716. doi: 10.14309/ajg.0000000000000969. PMID: 33982940.
Regulatory and Accreditation Guidelines (USA)
The Joint Commission
- The Joint Commission. Hospital Accreditation Standards https://www.jointcommission.org/standards/
- Hospital: 2022 National Patient Safety Goals https://www.jointcommission.org/standards/national-patient-safety-goals/hospital-national-patient-safety-goals/
- Process of Accreditation – https://www.jointcommission.org/accreditation-and-certification/become-accredited/learn-the-process/
- Jones MR, Karamnov S, Urman RD. Characteristics of Reported Adverse Events During Moderate Procedural Sedation: An Update. Jt Comm J Qual Patient Saf. 2018 Nov;44(11):651-662. doi: 10.1016/j.jcjq.2018.03.011. Epub 2018 Jul 27. PMID: 30064956.
- Procaccini D, Rapaport R, Petty B, et.al. Design and Implementation of an Analgesia, Sedation, and Paralysis Order Set to Enhance Compliance of pro re nata Medication Orders with Joint Commission Medication Management Standards in a Pediatric ICU. Jt Comm J Qual Patient Saf. 2020 Dec;46(12):706-714. doi: 10.1016/j.jcjq.2020.06.003. Epub 2020 Jun 10. PMID: 32653365.
Centers for Medicare and Medicaid Services
- CMS Clarification of the Interpretive Guidelines for the Anesthesia Services Condition of Participation (2010) https://www.hhs.gov/guidance/document/clarification-interpretive-guidelines-anesthesia-services-condition-participation
- CMS Revised Appendix A, Interpretive Guidelines for Hospitals (2020) https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107ap_a_hospitals.pdf
- Conditions for coverage and conditions of participation. Section 482.52. (2020) https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107ap_a_hospitals.pdf
Additional Resources
- Green SM, Norse AB, Jackson BF, et.al.; ACEP Regulatory Challenges to Emergency Department Procedural Sedation Task Force. Regulatory Challenges to Emergency Medicine Procedural Sedation. Ann Emerg Med. 2021 Jan;77(1):91-102. doi: 10.1016/j.annemergmed.2020.08.004. Epub 2020 Oct 21. PMID: 33353592.
- The Pediatric Procedural Sedation Handbook editor Gooden, Cheryl K et al, Chapter 17.2 Regulatory Issues, pp 392-398, October 2018.
- PubMed Search – Joint Commission & Hospital Accreditation (limited to last 5 years)
Administrative Guidelines
Credentialing & Competencies
- The ASA Standards, Guidelines and Statements https://www.asahq.org/standards-and-guidelines
- Statement of Granting Privileges for Administration of Moderate Sedation to Practitioners (2021) https://www.asahq.org/standards-and-guidelines/statement-of-granting-privileges-for-administration-of-moderate-sedation-to-practitioners
- Statement on Granting Privileges to Non-Anesthesiologist Physicians* for Personally Administering or Supervising Deep Sedation (2017) https://www.asahq.org/standards-and-guidelines/statement-on-granting-privileges-to-nonanesthesiologist-physicians-for-personally-administering-or-supervising-deep-sedation
- Society for Pediatric Sedation Consensus Statement: Core Competencies for Pediatric Providers Who Deliver Deep Sedation https://www.pedsedation.org/resources/quality-safety/core-competencies/
- American Academy of Pediatric Dentistry. Use of Anesthesia Providers in the Administration of Office-based Deep Sedation/General Anesthesia to the Pediatric Dental Patient. Pediatr Dent. 2018 Oct 15;40(6):317-320. PMID: 32074902.
- American Society of Plastic Surgeons. Considerations for Patient Selection and
- Procedures in Ambulatory Surgery. Approved by the Executive Committee March 2021.
Quality and Safety
Resources
- American Academy of Pediatrics – EQIPP – “QI Basics 101 Course”
- Agency for Healthcare Research and Quality – Comprehensive Unit-based Safety Program (CUSP) – Modular learning toolkit
- Institute for Healthcare Improvement – Open School
- Centers for Medicare & Medicaid Services – Guidance for Performing Failure Mode and Effects Analysis with Performance Improvement Projects
- PubMed Curated Search – Quality Improvement Projects
Acute Pain
Management Guidelines
- Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine. Prevention and Management of Procedural Pain in the Neonate: An Update. Pediatrics. 2016 Feb;137(2):e20154271. doi: 10.1542/peds.2015-4271. Epub 2016 Jan 25. PMID: 26810788.
- Lee GY, Yamada J, Kyololo O, Shorkey A, Stevens B. Pediatric clinical practice guidelines for acute procedural pain: a systematic review. Pediatrics. 2014 Mar;133(3):500-15. doi: 10.1542/peds.2013-2744. Epub 2014 Feb 2. PMID: 24488733.
- Villacres S, Chumpitazi CE. Acute Pediatric Pain Management in the Primary Care Office. Pediatr Ann. 2018 Mar 1;47(3):e124-e129. doi: 10.3928/19382359-20180222-01. PMID: 29538786.
International Guidelines
Procedural Sedation and Pain Management
- Balice-Bourgois C, Zumstein-Shaha M, Vanoni F, et.al. A Systematic Review of Clinical Practice Guidelines for Acute Procedural Pain on Neonates. Clin J Pain. 2020 May;36(5):390-398. doi: 10.1097/AJP.0000000000000808. PMID: 31977372.
- Burger A, Hodkinson PW, Wallis LA. (2019). Emergency Centre-based paediatric procedural sedation: current practice and challenges in Cape Town. Southern African Journal of Anaesthesia and Analgesia, 25(1),23-28.
- Dumonceau JM, Riphaus A, Schreiber F, et.al. Non-anesthesiologist administration of propofol for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates Guideline–Updated June 2015. Endoscopy. 2015 Dec;47(12):1175-89. doi: 10.1055/s-0034-1393414. Epub 2015 Nov 12. PMID: 26561915.
- Green SM, Leroy PL, Roback MG, et.al.; International Committee for the Advancement of Procedural Sedation. An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children. Anaesthesia. 2020 Mar;75(3):374-385. doi: 10.1111/anae.14892. Epub 2019 Dec 2. Erratum in: Anaesthesia. 2020 Jun;75(6):818. PMID: 31792941; PMCID: PMC7064977.
- Krmpotic K, Rieder MJ, Rosen D. Recommendations for procedural sedation in infants, children, and adolescents. Paediatr Child Health. 2021 Mar 16;26(2):128-129. doi: 10.1093/pch/pxaa139. PMID: 33747309; PMCID: PMC7962705.
- de Luca U, Mangia G, Tesoro S, et.al. Guidelines on pediatric day surgery of the Italian Societies of Pediatric Surgery (SICP) and Pediatric Anesthesiology (SARNePI). Ital J Pediatr. 2018 Mar 12;44(1):35. doi: 10.1186/s13052-018-0473-1. PMID: 29530049; PMCID: PMC5848546.
- Riphaus A, Wehrmann T, Hausmann J, et.al. Update S3-guideline: “sedation for gastrointestinal endoscopy” 2014 (AWMF-register-no. 021/014). Z Gastroenterol. 2016 Jan;54(1):58-95. doi: 10.1055/s-0041-109680. Epub 2016 Jan 11. PMID: 26751118.
- Riphaus, A. (2009). S3 Guideline: sedation for gastrointestinal endoscopy. Endoscopy, 41(9), 787.815.
- 2018 surveillance of sedation in under 19s: using sedation for diagnostic and therapeutic procedures (NICE guideline CG112) [Internet]. London: National Institute for Health and Care Excellence (NICE); 2018 Dec 12. PMID: 31855335.
- Roelofse J, Jansen van Rensburg M, Gray R, Lapere C, South African Society of Anesthesiologists. SASA paediatric guidelines for the safe use of procedural sedation and analgesia for diagnostic and therapeutic procedures in children: 2021–2026 Southern African Journal of Anaesthesia and Analgesia 2021;27(4 Supplement 2):S1-83.
- Zielinska M, Bartkowska-Sniatkowska A, et.al. Safe pediatric procedural sedation and analgesia by anesthesiologists for elective procedures: A clinical practice statement from the European Society for Paediatric Anaesthesiology. Paediatr Anaesth. 2019 Jun;29(6):583-590. doi: 10.1111/pan.13615. Epub 2019 Mar 13. PMID: 30793427.