Guidelines for the Elective Use of Conscious Sedation, Deep Sedation, and General Anesthesia in Pediatric Patients

Abstract

The goals of sedation and general anesthesia in the ambulatory patient are: (1) patient welfare; (2) control of patient behavior; (3) production of positive psychological response to treatment; and (4) return to pretreatment level of consciousness by time of discharge. DEFINITION OF TERMS Terms used in this document are defined as follows: Pediatric patients: Includes all patients who are infants, children, and adolescents less than age of majority. Must or shall: Indicates an imperative need and/or duty; as essential or indispensable; mandatory. Should: Indicates the recommended manner of obtaining the standard; highly desirable. May or could: Indicates freedom or liberty to follow a suggested or reasonable alternative. Conscious sedation: Conscious sedation is a minimally depressed level of consciousness that retains the patient's ability to maintain a patent airway independently and continuously, and respond appropriately to physical stimulation and/or verbal command, eg, "Open your eyes." For the very young or handicapped individual, incapable of the usually expected verbal responses, a minimally depressed level of consciousness for that individual should be maintained. The caveat that loss of consciousness should be unlikely is a particularly important part of the definition of conscious sedation, and the drugs and techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Deep sedation: Deep sedation is a controlled state of depressed consciousness or unconsciousness from which the patient is not easily aroused, which may be accompanied by a partial or complete loss of protective reflexes, including the ability to maintain a patent airway independently and respond purposefully to physical stimulation or verbal command.