J Korean Soc Emerg Med.  2012 Jun;23(3):303-314.

Korean Guidelines for Pediatric Procedural Sedation and Analgesia

Affiliations
  • 1Department of Emergency Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.
  • 2Department of Emergency Medicine, Inje University Seoul Paik Hospital, Seoul, Korea.
  • 3Department of Emergency Medicine, The Catholic University of Korea, Uijeongbu, Korea.
  • 4Department of Emergency Medicine, Jecheon Myongji Hospital, Jecheon, Korea.
  • 5Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
  • 6Department of Emergency Medicine, Gimhae Jungang Hospital, Gimhae, Korea.
  • 7Department of Emergency Medicine, Gachon University of Medicine and Science, Incheon, Korea.
  • 8Department of Pediatrics, Gachon University of Medicine and Science, Incheon, Korea.
  • 9Department of Emergency Medicine, Hanil General Hospital, Korea Electric Power Medical Corporation, Seoul, Korea.
  • 10Department of Emergency Medicine, Dongguk University Ilsan Hospital, Ilsasn, Korea.
  • 11Department of Emergency Medicine, Dankook University Hospital, Cheonan, Korea.
  • 12Yeouido St. Mary's Hospital, Emergency Department, Seoul, Korea.
  • 13Asan Medical Center, Children's Hospital, Department of Emergency Medicine, Pediatric Emergency Center, Seoul, Korea.
  • 14Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea.
  • 15Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang, Korea.
  • 16Department of Emergency Medicine, College of Medicine, Inha University, Incheon, Korea. LIFSAV@inha.ac.kr

Abstract

Procedural sedation and analgesia (below PSA), which is used for induction of appropriate sedation and elimination of pain during many procedures, is particularly essential for children. Many other countries have pediatric PSA guidelines. PSA guidelines are also needed in Korea. We have developed pediatric PSA guidelines for Korea by reference review of pediatric PSA for standard and safe PSA practice in Korea. Pharmacologic and non-pharmacologic methods could be used for performance of ideal pediatric PSA. Pre sedation phase included assessment of patients, with accompanying personnel who have adequate knowledge and experience, and informed consent. For sedation phase, the route of medication should be determined, along with monitoring of patients and evaluation of the depth of sedation. This phase also included writing all of the PSA process, adverse events, and intervention. Considering the pain of the procedures, the time of procedures, necessity for immobilization, and characteristics of PSA medication, we decided on the PSA method. Procedures were categorized into three types according to the level of pain, anxiety, and immobilization. The first type was radiologic imaging, which requires immobilization. The second type of procedure involves a high level of anxiety and a low level of pain, such as simple suturing and lumbar puncture. The third type of procedure involves a high level of anxiety and a high level of pain, such as reduction of fracture and dislocation. After performance of the procedure, patients must be observed and monitored at a location where oxygen and airway management can be applied until they reach full recovery. Discharge information should be provided to competent parents. The main characteristics of Korean guidelines for pediatric PSA were as follows: 1. We emphasized assessment and monitoring of patients during and after PSA. 2. We suggested selection of medication by categorization of procedures according to the level of pain and anxiety. 3. We suggest that PSA be performed by two healthcare personnel; one should have adequate knowledge and experience in performance of PSA. More equipment, locations, and specialized personnel are needed for conduct of safe pediatric PSA practice in Korea.

Keyword

Pediatrics; Conscious sedation; Analgesia; Guideline
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