Procedural Sedation

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Procedural Sedation

  • The phrase “procedural sedation” refers to techniques of managing a patient’s pain and anxiety to facilitate appropriate medical care in a safe, effective and humane fashion.

Chloral Hydrate

Chloral Hydrate

  • Usually given to Outpatients due to relative low risk profile. For non-painful procedures only.

    • EEGs
    • MRI/CT Scans
    • Echocardiograms

Chloral Hydrate

  • PO/Rectal

  • Dose: 50mg/kg give 30-60 minutes prior to procedure.

  • Can repeat x1 25mg/kg

  • Not to exceed 100mg/kg in a 24 hour period

Chloral Hydrate

  • Expect a moderate decrease in heart rate and blood pressure in patients ASA I-II

  • For infants < 6 months there is ↑ risk for apnea and hypoxia.

  • Age a limiting factor. High failure rate in children > 4 years.

Pentobarbital : Nembutal®


  • PO/Rectal/IM/IV

  • Dose for procedural sedation:

  • 4mg/kg , may repeat 2mg/kg, max 100mg

Nembutal: precautions

  • Rapid IV injection ie, can cause respiratory depression, apnea, laryngospasm, bronchospasm and hypotension

  • Recommended to infuse IV dose over 10-30 minutes.

  • Can significantly decrease cardiac output and should be avoided with CHF


  • Midazolam- Versed®

  • Lorazepam - Ativan®

  • Induce anterograde amnesia (not retrograde)

  • May have some opioid sparing effect by ↓ anticipatory pain response

Midazolam -® Versed

  • Most commonly used Benzo for preoperative and pre-procedural sedation.

  • Undergoes hepatic metabolism and renal excretion and prolonged effects seen with dysfunction of either system

  • Sedative, amnestic and anxiolytic with no analgesic properties

  • Commonly used with an opioid analgesic such as Fentanly®


  • Onset in 1 to 2 minutes

  • Duration 30 min

  • Caution for respiratory depression and hypotension

Fentanyl- Sublimaze®

  • Used in combination with Versed for many years due to rapid onset and effectiveness

  • Synthetic opioid

  • Metabolized by the liver

  • Short duration of effect

  • Pure analgesic (should not be

  • used alone)

  • Least histamine release of opiates


  • Dosage for Pediatrics:

  • -IM or IV 0.5-1.0 mcg/kg/dose

  • -onset 1-2 min

  • -lasts 30 minutes


  • Classified as a general anesthetic

  • Rapid acting dissociative anesthetic that produces a profound analgesic effect

  • Gaining favor in children due to reliable effects and strong safety profile


  • IV 1-2 mg/kg/dose

  • -Onset is 1 minute

  • -Duration 10-20 minutes

  • IM 2-4 mg

  • -onset 5 minutes

  • -duration 15-45 minutes


  • Classified as a general anesthetic

  • -Lower doses

  • sedation

  • hypnosis

  • Anmestic, anxiolytic, antiemetic, and

  • antiepileptic properties

  • No Analgesic effects


  • Dosing 2.5 -3.5 mg/kg/ dose over 20-30 seconds

  • Onset 10-30 seconds

  • Duration 10-20 minutes

  • For prolonged procedures may require continuous infusion 125-300mcg/kg/minute. (smaller children may require smaller infusion rates.

Propofol Caution

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