Procedural sedation

Frequently part of diagnosing and treating an illness requires children to undergo a procedure. Some procedures are very simple, quick and have no pain associated with them. However, unfortunately, some procedures require children to stay still for a long period of time, and can be uncomfortable and sometimes cause pain and distress.

The aim of staff will be to reduce the uncomfortable, painful or stressful part of procedures as much as possible.

Before you come to hospital for the procedure, the best thing you can do is to prepare your child at home. Always answer any questions your child may have. (See fact sheet Children's painful procedures and operations: how can parents help?)

If your doctor has asked your child to fast or be 'nil by mouth' for a certain period before coming in to the procedure it is important to follow the instruction. This is to reduce the chance of your child choking while having the sedation. If you are not sure about the fasting instructions please contact your doctor that is performing the procedure or the ward/unit where the procedure is going to occur.

Before the procedure a nurse or your child's doctor will check your child to help decide how to best manage any pain or distress they may have during the planned procedure. They will need to ask about your child's health, any past experiences, your family history, and they may need to examine your child. It is important to mention if your child has any problems with breathing, such as snoring or past problems with anaesthetics.

Your child may need some medicine to prevent and/or relieve pain, reduce anxiety or sometimes to make them sleepy and able to lie still. Analgesics are medicines that reduce your child's pain, but there are other things that may upset your child such as strange places, noises, people and having to lie still. For that reason sedatives (drugs that make you sleepy) may be offered. There are many different types and different ways of giving both these medicines such as syrup, tablets, needles and breathing nitrous oxide (laughing gas). Your child's doctor will discuss this with you and your child, and explain how sleepy they may make your child, what the side-effects could be, what risks there are, and how long these medicines can affect your child. You are encouraged to ask questions so that you and your child can help make the choices.

Once your child has been given the medicines, he/she should be kept on your lap or in a bed or cot. If they are in a bed or cot and you are not sitting right beside them the sides should be in the up position. If your child is very sleepy they should be put in the cot or bed lying flat or on their side.

You will be asked to stay where your child can be observed until the medicine takes effect and again after the procedure while the effect of the medication wears off. The reason we ask for this is that these special medicines (sedatives and analgesics) can make your child a little bit uncoordinated or clumsy. Depending on the medicines your child may need to be monitored from the time they are sleepy until they are fully awake. This usually is done by placing an 'oximeter' probe on their finger (a machine with a little peg or clip that shines a light at the finger). This machine will check their oxygen level (gas in the blood that shows breathing) and heart rate. Their pain and distress will also be checked frequently.

Following the procedure, once your child is awake and back to their normal self, they will be checked by a nurse and allowed to go home, as long as they will be cared by an adult for the rest of the day. You will also be given discharge instructions before you leave.

It is common that when you leave the hospital your child may want to go back to sleep. At this time it is best for them to be lying down in their pram, or if in the car, the best position is one where their head is upright and supported in their car child restraint. This is because some medicines may still be having some effect and your child's sleep may be deeper than usual and they may not keep their head in a good position to breath.

Adolescents should not drive or use heavy machinery for 12- 24 hours after sedation (depending on the medicines used).

• On the day of the procedure bring your child's favourite book or music, or even a small game to play!
• As a parent you play a very important role in assisting your child to cope with medical procedures that can be distressing and uncomfortable.