Outpatient Procedural Sedation and Analgesia (Children)

Our hospital has adopted procedural sedation as a standard protocol for young patients undergoing procedures that require the child to keep still. This practice is considered very safe. This document excludes procedural sedation performed in the Children's Emergency department.

What is Procedural Sedation and Analgesia (PSA)?

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

• Bone marrow aspiration
• Cardiac scan
• Diagnostic imaging scans, such as CT scan, MRI scan and Nuclear Medicine study
• Electroencephalogram (EEG)
• Extensive wound dressing
• Hearing test
• Hickman line removal
• Intramuscular Botox injection
• Lumbar puncture (spinal fluid aspiration)

If your child receives PSA as an outpatient, he/she can go home on the same day.

The sedative may be administered orally or by injection. For painful procedures, analgesics (painkillers) and/or local anaesthetic medication are also given. Your child will be monitored closely throughout the procedure. After the procedure, mild pain can be relieved with oral medication (e.g. paracetamol).

Commonly used drugs include:

• Chloral hydrate
• Dexmedetomidine
• Ketamine
• Midazolam

Are There Any Side Effects?

Side effects of the medicines used for PSA include:

• Nausea and vomiting
• Rashes
• Diarrhoea
• Agitation or euphoria
• Respiratory depression
• Drop in blood pressure

Most side effects are self-limiting and usually resolve after one to two hours, or after treatment. It is rare for a child to develop a severe allergic reaction to the medicines used in PSA. Appropriate and prompt treatment will be given if this occurs.

Is Fasting Required?

Yes. A minimum of three hours of fasting is necessary before the appointment time.

Please follow fasting instructions given by the doctor or nurse strictly:

• Ensure that your child's last meal is light: up to 1 cup of milk or Milo, and not more than 2 pieces of plain biscuits or 1 slice of plain bread.
• Avoid heavy and oily meals which increase the risk of vomiting and food going into the lungs (aspiration). Aspiration can be life threatening.
• Water is allowed up to 1-2 hours before your child’s procedure. Please ensure your child does not drink more than the maximum volume allowed per hour:
  • Under 1 year old: 25mls per hour
  • 1-5 years old: 50mls per hour
  • 6 years old and above: 100mls per hour
• If instructed, oral medication to be taken on the day of the procedure must be taken before the stop time for water. Your child should keep to the maximum amount of water allowed for that hour.
• Important: Please note that if your child does not observe fasting as instructed, the procedure will be postponed or cancelled for your child’s safety.

Who Is Not Suitable for PSA?

• A patient with known allergy to medicines used for PSA
• A patient who has taken a meal less than three hours before PSA
• A patient with an ongoing respiratory tract infection
• A patient with an unstable medical condition
  

If My Child Is Sick with Fever, Flu or a Runny Nose, Can He/she Still Undergo Sedation?

No. Please inform the respective clinic/hospital department. The appointment will be rescheduled to at least two weeks after your child has recovered from the acute illness.

What Else Do I Need to Know?

After the procedure:

• Before being discharged from sedation monitoring and allowed any food or drink, your child will be assessed by a doctor or nurse.
• Your child may be at risk of falls and other side effects. Please supervise your child at all times for the next 4-6 hours after PSA.
• Avoid activities such as swimming, riding a bicycle, scooter or skateboard.
• Avoid giving your child medications that cause drowsiness.
• Please supervise your child on the journey home, especially if he/she is in a car seat, to ensure the head does not flop forward as this could obstruct his/her breathing.
  

When to seek emergency care:

You should bring your child to the Children's Emergency at Children's Tower, Basement 1, KK Women’s and Children’s Hospital if:

• Your child remains drowsy or feels unwell.
• Your child is in severe pain despite taking painkillers.

Useful Information

Useful information

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

• Registration
• Administration of sedation
  

As consent for procedural sedation is required, a parent or legal guardian should accompany the child for the procedure.

Please bring along a comfort object such as a favourite toy or pillow, and other necessities such as adequate milk powder, diapers and an extra change of clothes.