Procedural Sedation and Anesthesia in the PICU

  • Stephen D. Playfor
  • Katherine Kirkpatrick


Critically ill children in the Pediatric Intensive Care Unit (PICU) frequently undergo painful and anxiety-provoking procedures as part of their overall evaluation and management; these may include central line insertion, arterial line placement, chest tube placement, and lumbar puncture. Recently there has been a growing trend towards performing elective diagnostic and therapeutic procedures in children, which formerly required hospitalization, as same-day ambulatory procedures. Procedural sedation is often utilized to facilitate the safe and successful performance of these ambulatory procedures in children, in order to minimize complications and decrease the pain and anxiety associated with them.

Prior to the administration of procedural sedation it is important that adequate preparation has taken place in order to maximize patient safety. Preparation should include a full health evaluation noting the fasting status, performance of a guided risk assessment, assignment of a physical status score, and the generation of a sedation plan. Minimum monitoring standards should be maintained from the administration of sedative agents until the recovery criteria are met.

Non-pharmacological measures can be very useful in alleviating anxiety on the part of the patient and may reduce the need for pharmacological agents. Massage, music, video-viewing, nursery rhymes and story telling are all techniques frequently employed on the PICU during painful procedures.

Pharmacological agents commonly used to facilitate procedural sedation include chloral hydrate, benzodiazepines such as midazolam, ketamine and propofol.


Sedation Procedures Midazolam Ketamine Propofol 


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Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Paediatric Intensive Care UnitRoyal Manchester Children’s HospitalManchesterUK
  2. 2.Department of Paediatric AnaesthesiaRoyal Manchester Children’s HospitalManchesterUK

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