SCOPE OF THE PROBLEM

The pediatric population accounts for a large percentage of emergency department (ED) visits annually. Many of these patients will require brief, painful procedures either in the ED or in another setting such as the intensive care unit. These procedures also occur frequently in the outpatient clinic or inpatient setting for children with chronic illnesses. To affect an optimal procedural experience for these patients, a pediatric procedure unit or clinical response team of well-trained caregivers has been a recent trend.

Typical procedures for these patients include lumbar puncture, bone marrow aspiration, and central venous catheter placement. These procedures, and other brief diagnostic and therapeutic procedures in this population, are similar to the adult population in the intervention and technique required. They are distinct from their adult counterparts, however, in that the pediatric patient will often require sedation and anxiolysis owing to the child's fear, in addition to a need to create an experience that is positive and supportive instead of a recurrent, negative association with medical care. Younger patients will also often require a brief period of sedation to optimize positioning or minimize movement.

It has been previously documented that there is considerable underuse of analgesia and sedation in children requiring brief, painful medical interventions. The goal of procedural sedation in this setting is to provide sedative, analgesic, and/or dissociative agents to alter recognition of pain and level of consciousness, at the same time maintaining airway reflexes in order to provide symptomatic relief of pain and anxiety.