In this EM Cases episode on Pediatric Procedural Sedation with Dr. Amy Drendel, a world leader in pediatric pain management and procedural sedation research, we discuss how best to manage pain and anxiety in three situations in the ED: the child with a painful fracture, the child who requires imaging in the radiology department and the child who requires a lumbar puncture.
Performing safe and effective procedural sedation in children requires the same foundational elements as other age groups – skilled personnel, an equipped setting and a structure to manage patients across the sedation continuum. However, children have unique developmental and physiologic vulnerabilities that require special consideration when planning and performing sedation.
Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016 [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Pediatrics. 2016 Jul;138(1). pii: e20161212. doi: 10.1542/peds.2016-1212.
Air Embolism 2 – Anaphylaxis 3 – Anterior Mediastinal Mass 4 – Bradycardia 5 – Cardiac Arrest 6-8 – Difficult Airway 9 – Fire: Airway / OR 10-11 – Hyperkalemia 12 –
Hypertension 13 – Hypotension 14 – Hypoxia 15-16 – Intracranial Pressure 17 –
Local Anesthetic Toxicity 18 – Loss of Evoked Potentials 19 – Malignant Hyperthermia 20 –
Myocardial Ischemia 21 – Pulmonary Hypertensive Crisis 22 – Tachycardia 23 –
Tension pneumothorax 24 – Transfusion & Reactions 25-26 – Trauma
Pediatric Procedural Sedation GCEP lecture by Lopez 29:47 YouTube video by Daniel McCollum. Published on Oct 4, 2015:
This is a lecture on pediatric procedural sedation by Dr. Mark Lopez. He presented this lecture on 9-27-15 at the Rural Emergency Medicine conference presented by GCEP. In it, he discusses how to safely and effectively sedate pediatric patients in order to provide timely care.
Larson Maneuver for the Treatment of Laryngospasm 0:27 YouTube video by NEJMvideo
Published on Mar 27, 2014:
Laryngospasm, a common complication after extubation [and Dr. Lopez, in the GCEP video above, states that laryngospasm occurs in 0.4% of ketamine procedural sedations] can be treated by the Larson maneuver — a simple maneuver involving bilateral digital pressure in the laryngospasm notch [well demonstrated in this video].
Pediatric Moderate Sedation 1:32:39 YouTube video by UMMCVideos
Uploaded on Jun 28, 2010:
This video provides an overview of the pediatric moderate sedation services offered at the University of Maryland Medical Center. The presentation is delivered by Dr. Anne Savarese, an assistant professor of Anesthesiology at the University of Maryland School of Medicine and director of Pediatric Anesthesiology and Pediatric Pain at the University of Maryland Medical Center.
Intranasal sedation for pediatric patients 47:45 YouTube Video by Jay Pershad, M.D.
Le Bonheur Children’s Hospital
Lecture was in Tupelo, Mississippi
June 6, 2013
Moderate Sedation Simulator 1:16:04 YouTube Video by Michael Eslinger
Published on Aug 14, 2014:
Anesoft’s Moderate Sedation Simulator demonstrated to a live Sedation class. This simulator is a great and fun way for nurses, MDs, DOs and other medical personnel to practice moderate sedation techniques.
You can try the simulator for yourself at