Paediatric sedation guidelines: where we came from, where we are now, and current drug controversies

Abstract

The American Academy of Pediatrics (AAP) became interested in sedation disasters in 1983 when three children died in a single dental office. The AAP asked the Section on Anesthesiology to help develop guidelines for monitoring children sedated by nonanaesthesiologists. I had the good fortune to co-author this first sedation guideline in 19851 Subsequently, the AAP recognised that the guideline was being ignored by general paediatric practitioners, particularly those in the emergency room, radiology, and other areas where sedation is widely used. Therefore, the guideline was revised in 1992 with a new title, and emphasis was placed on “systems issuesâ€.2 A major source of confusion was the definition of “conscious sedationâ€, which was defined as “a purposeful response to either a painful stimulus or a verbal command.†Some practitioners interpreted reflex withdrawal to pain as being consistent with “conscious sedationâ€, and this led to a number of accidents. This term is contradictory to what really happens to children, and is misleading.3