Guidance
Key priorities for implementation
Key priorities for implementation
Pre‑sedation assessment, communication, patient information and consent
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Ensure that trained healthcare professionals (see section 1.4) carry out pre‑sedation assessments and document the results in the healthcare record.
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Establish suitability for sedation by assessing all of the following:
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current medical condition and any surgical problems
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weight (growth assessment)
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past medical problems (including any associated with previous sedation or anaesthesia)
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current and previous medication (including any allergies)
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physical status (including the airway)
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psychological and developmental status.
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Seek advice from a specialist before delivering sedation:
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if there is concern about a potential airway or breathing problem
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if the child or young person is assessed as American Society of Anesthesiologists (ASA) grade 3 or greater (the ASA physical status classification system [grades 1 to 6] is a system to classify and grade a patient's physical status before anaesthesia).
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for infants, including neonates.
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Ensure that both the following will be available during sedation:
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a healthcare professional and assistant trained (see section 1.4) in delivering and monitoring sedation in children and young people
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immediate access to resuscitation and monitoring equipment (see section 1.5).
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Choose the most suitable sedation technique based on all the following factors:
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what the procedure involves
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target level of sedation
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contraindications
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side effects
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patient (or parent or carer) preference.
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Personnel and training
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Healthcare professionals delivering sedation should have knowledge and understanding of and competency in:
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sedation drug pharmacology and applied physiology
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assessment of children and young people
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monitoring
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recovery care
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complications and their immediate management, including paediatric life support.
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Healthcare professionals delivering sedation should have practical experience of:
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effectively delivering the chosen sedation technique and managing complications
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observing clinical signs (for example, airway patency, breathing rate and depth, pulse, pallor and cyanosis, and depth of sedation)
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using monitoring equipment.
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Ensure that all members of the sedation team have basic life support skills for minimal, moderate and deep sedation. At least 1 team member should have intermediate life support skills for moderate sedation and advanced life support skills for deep sedation. Minimal sedation includes sedation with nitrous oxide alone (in oxygen) and conscious sedation in dentistry.
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Healthcare professionals delivering sedation should have documented up‑to‑date evidence of competency including:
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satisfactory completion of a theoretical training course covering the principles of sedation practice
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a comprehensive record of practical experience of sedation techniques, including details of:
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sedation in children and young people performed under supervision
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successful completion of work‑based assessments.
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Clinical environment and monitoring
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For deep sedation continuously monitor, interpret and respond to all of the following:
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depth of sedation
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respiration
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oxygen saturation
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heart rate
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three‑lead electrocardiogram
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pain
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coping
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distress.
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Also continuously monitor, interpret and respond to the following, provided that monitoring does not cause the patient to awaken and so prevent completion of the procedure:
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end tidal CO2 (capnography)
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blood pressure (monitor every 5 minutes)
The healthcare professional administering sedation should be involved only in continuously monitoring, interpreting and responding to all of the above.
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