Abstract
Assessing the depth of sedation in children is critically important to determine whether the goals of sedation are met without exposing the patient to the risk of adverse outcomes. In Cravero’s model of pediatric sedation, the patient’s state ranges from fully awake undergoing a painful procedure without sedation or analgesia to apnea, hypoxia, and death from oversedation. Clearly, having the sedated child’s state in the goal zone is important, and objective tools to assess sedation depth are necessary to standardize depth of sedation. Additionally, having objective assessment scales available to rate a child’s readiness for discharge from a sedation recovery area is also important, as premature discharge may lead to adverse events and even death. This chapter will review commonly used pediatric sedation scales, focusing on procedural sedation. Then methods of sedation assessment using processed EEG will be reviewed and compared to pediatric sedation scales.
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References
Cravero JP, Blike GT, Surgenor SD, Jensen J. Development and validation of the Dartmouth Operative Conditions Scale. Anesth Analg. 2005;100:1614–21.
Cote CJ, Karl HW, Notterman DA, et al. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics. 2000;106:633–44.
Malviya S, Voepel-Lewis T, Prochaska G, Tait AR. Prolonged recovery and delayed side effects of sedation for diagnostic imaging studies in children. Pediatrics. 2000;105(3):e42.
Malviya S, Voepel-Lewis T, Tait AR. Adverse events and risk factors associated with sedation of children by non-anesthesiologists. Anesth Analg. 1997;85:1207–13.
Cote CJ, Wilson S. The work group on sedation. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006;118:2587–602.
Kaplan RF, Cravero JP, Yaster M, Cote C. Sedation for diagnostic and therapeutic procedures outside the operating room, chap. 48. In: Cote CJ, Lerman J, Todres ID, editors. A practice of anesthesia for infants and children. Philadelphia: Saunders Elsevier; 2009. p. 1023–48.
Reeves ST, Havidich JE, Tobin DP. Conscious sedation of children with propofol is anything but conscious. Pediatrics. 2004;114:e74–6.
Cravero JP, Beach ML, Blike GT, et al. The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the pediatric sedation research consortium. Anesth Analg. 2009;108:795–804.
Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. BMJ. 1974;2:656–9.
De Jonghe B, Cook D, Appere-De-Vecchi C, et al. Using and understanding sedation scoring systems: a systematic review. Intensive Care Med. 2000;26(3):275–85.
Chernik DA, Gillings D, Laine H, et al. Validity and reliability of the observer’s assessment of alertness/sedation scale: study with intravenous midazolam. J Clin Psychopharmacol. 1990;10:244–51.
Shannon M, Albers G, Burkhart K, et al. Safety and efficacy of flumazenil in the reversal of benzodiazepine-induced conscious sedation. J Pediatr. 1997;131:582–6.
Madan R, Kapoor I, Balachander S, et al. Propofol as a sole agent for pediatric day care diagnostic ophthalmic procedures: comparison with halothane anesthesia. Paediatr Anaesth. 2001;11:671–7.
Malviya S, Voepel-Lewis T, Tait AR, et al. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth. 2002;88:241–5.
Sadhasivam S, Ganesh A, Robison A, et al. Validation of the bispectral index monitor for measuring the depth of sedation in children. Anesth Analg. 2006;102:383–8.
Ambuel B, Hamlett KW, Marx CM, Blumer JL. Assessing distress in pediatric intensive care environments: the COMFORT scale. J Pediatr Psychol. 1992;17:95–109.
Zhong L, Shen K, Zhai S, et al. Application of sedation-agitation scale in conscious sedation before bronchoscopy in children. Medicine (Baltimore). 2019;98:e14035.
Malviya S, Voepel-Lewis T, Tait AR, Watcha MF, Sadhasivam S, Friesen RH. Effect of age and sedative agent on the accuracy of bispectral index in detecting depth of sedation in children. Pediatrics. 2007;120:e461–70.
Haberland CM, Baker S, Liu H. Bispectral index monitoring of sedation depth in pediatric dental patients. Anesth Prog. 2011;58:66–72.
Mason KP, Michna E, Zurakowski D, et al. Value of bispectral index monitor in differentiating between moderate and deep Ramsay sedation scores in children. Paediatr Anaesth. 2006;16:1226–31.
Malviya S, Voepel-Lewis T, Tait AR. A comparison of observational and objective measures to differentiate depth of sedation in children from birth to 18 years of age. Anesth Analg. 2006;102:389–94.
Davidson AJ. Monitoring the anaesthetic depth in children—an update. Curr Opin Anaesthesiol. 2007;20:236–43.
Giordano V, Deindl P, Goeral K, et al. The power of N-PASS, aEEG, and BIS in detecting different levels of sedation in neonates: A preliminary study. Paediatr Anaesth. 2018;28:1096–104.
Cheung YM, Scoones GP, Hoeks SE, et al. Evaluation of the aepEX™ monitor of hypnotic depth in pediatric patients receiving propofol-remifentanil anesthesia. Paediatr Anaesth. 2013;23:891–7.
Robinson BR, Berube M, Barr J, et al. Psychometric analysis of subjective sedation scales in critically ill adults. Crit Care Med. 2013;41(9 Suppl 1):S16–29.
Green SM, Mason KP. Reformulation of the sedation continuum. JAMA. 2010;303:876–7.
Mason KP, Burrows PE, Dorsey MM, et al. Accuracy of capnography with a 30 foot nasal cannula for monitoring respiratory rate and end-tidal CO2 in children. J Clin Monit Comput. 2000;16:259–62.
Lightdale JR, Goldmann DA, Feldman HA, et al. Microstream capnography improves patient monitoring during moderate sedation: a randomized, controlled trial. Pediatrics. 2006;117:e1170–8.
Waugh JB, Epps CA, Khodneva YA. Capnography enhances surveillance of respiratory events during procedural sedation: a meta-analysis. J Clin Anesth. 2011;23:189–96.
Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970;49:924–34.
Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7:89–91.
Malviya S, Voepel-Lewis T, Ludomirsky A, et al. Can we improve the assessment of discharge readiness?: a comparative study of observational and objective measures of depth of sedation in children. Anesthesiology. 2004;100:218–24.
Steward DJ. A simplified scoring system for the postoperative recovery room. Can Anaesth Soc J. 1975;22:111–3.
Finkel JC, Cohen IT, Hannallah RS, et al. The effect of intranasal fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing surgery for bilateral myringotomy tube placement. Anesth Analg. 2001;92:1164–8.
Bevan JC, Veall GR, Macnab AJ, et al. Midazolam premedication delays recovery after propofol without modifying involuntary movements. Anesth Analg. 1997;85:50–4.
Sury MR, Bould MD. Defining awakening from anesthesia in infants: a narrative review of published descriptions and scales of behavior. Paediatr Anaesth. 2011;21:364–72.
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Andropoulos, D.B. (2021). Sedation Scales and Discharge Criteria: How Do They Differ? Which One to Choose? Do They Really Apply to Sedation?. In: Mason, MD, K.P. (eds) Pediatric Sedation Outside of the Operating Room. Springer, Cham. https://doi.org/10.1007/978-3-030-58406-1_5
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DOI: https://doi.org/10.1007/978-3-030-58406-1_5
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