Procedural Sedation and Analgesia (Children)

Our hospital has adopted procedural sedation as a standard protocol for young patients who are undergoing procedures that require the child to keep still. This practice is found to be a very safe process.

In procedural sedation, medicines are used to sedate children who need to undergo short and/or painful hospital procedures. These include:

• Bone marrow aspiration
• Cardiac scan
• Central line insertion
• Chest tube insertion
• Chest tube removal
• Diagnostic imaging scans such as CT scan, MRI and Nuclear Medicine
• Electroencephalogram (EEG)
• Extensive dressing
• Hearing test
• K wire removal
• Long line insertion
• Simple manipulation and reduction of limbs
• Spinal fluid aspiration
  
  

The sedation may be given orally or via injection. Many outpatients procedures can be done under PSA, hence your child may not need not be admitted. In painful procedures, analgesic (painkillers) and/or local anaesthetic medications are used to relieve pain. After the procedure, the pain is relieved by oral medication (eg. Paracetamol). He/she will be monitored closely for breathing and other functions throughout the procedure.

Commonly used drugs are:

• Chloral Hydrate
• Ketamine
• Midazolam
  
  

Side effects of the medicines used for PSA include:

• Nausea and vomiting
• Rashes
• Diarrhoea
• Agitation or euphoria
• Respiratory depression
• Hypotension
  
  

Most side effects are self-limiting and usually resolve after one to two hours, or after treatment.

It is rare for the child to develop a bad allergic reaction to the medicines used in PSA such as sudden tightness of voice-box affecting breathing. Appropriate treatment will be given to minimise side effects.

Yes. A minimum of three hours of fasting is necessary before the appointment time, or as instructed by the doctor or nurse.

Fasting instructions:
Please ensure that the last meal is light: plain milk (maximum one cup) with plain biscuits or plain bread (maximum two pieces). Heavy oily meals can cause child to vomit and the food can go into the lungs causing life-threatening complications. This is because heavy oily meals tend to stay longer in the stomach and increase the risk of vomiting.

• Patients with known allergy to the medicine used for PSA
• Patients who have taken a meal less than three hours before PSA
• Patients with an ongoing respiratory tract infection
• Patients with unstable medical disease
  
  

No. It is advisable to reschedule another appointment in the event of acute illness after seven days of the appointment.

You may want to take note of the following:

• Your child may fall asleep during transit. This is normal. However, your child will be able to come around when you wake him/her up.
• Your child may resume his normal diet after he/she is fully recovered from sedation.
• Observe your child's activities. The effects of the sedation may last up to a few hours.
  
  

• Supervise your child at all times for the next four hours after procedure.
  
  

• Avoid the following activities such as riding a bicycle, scooter or skateboard.
• Avoid giving your child medications which cause drowsiness.
• Do supervise your child when he/she is placed in the car seat. The motion of his/her head flopping forward during the car journey may cause the tongue to obstruct his/her breathing.
  
  

You should bring your child to the Children's Emergency at Children's Tower, Basement 1 in the following situations:

• If your child remains drowsy or feels unwell.
• In severe pain despite taking painkillers
  
  

For outpatient appointments, please arrive 45 minutes before the procedure time for:

• Registration
• Administration of sedation
  
  

As consent may be required, a parent/legal guardian should accompany the child for the procedure. Bring along a favourite toy/pillow and adequate milk powder and diapers.