Pediatric sedation for emergency, imaging and endoscopic procedures: a worldwide review from the last five years
- Journal of Pediatrics & Neonatal Care
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Ana Clara Monteiro Laranjeira,<sup>1</sup>
Fernanda
Cardoso Andrade,<sup>2</sup>
Léa Jenifer Souza
Cordeiro,<sup>2</sup>
Letícia Barros Cardoso,<sup>2</sup>
Beatriz
Metedeiro Nunes Câmara,<sup>2</sup>
Júlia Carvalho
de Miranda,<sup>2</sup>
Patrícia Fabiane Monteiro
Laranjeira<sup>3</sup>
Abstract
Introduction: Anatomical, physiological, pharmacokinetic, pharmaco dynamic and behavioral particularities relevant to the pediatric population make its sedation challenging for quick and low-complexity procedures. Robust evidence on this subject is still scarce, and the variety of drugs available, with their multiple routes of administration and dosage schemes, makes it difficult for providers to make a decision.
Methods: Through research in four databases, we found 170 articles that addressed pediatric
sedation and, after applying the exclusion criteria, we selected 32 articles for analysis.
Results: In sedation for invasive or painful procedures, Esketamine in monotherapy was
effective, despite the significant incidence of adverse effects.
Satisfactory responses were also obtained with associations between Esketamine and
Propofol and Fentanyl with Propofol or Midazolam. To perform imaging tests, continuous
infusions of Propofol or Dexmedetomidine were sufficient, with associations with
Esketamine or opioids associated with a higher incidence of adverse effects.
Endoscopic procedures have been successfully performed after administration of
continuous infusion of Propofol or Dexmedetomidine, associated with Remifentanil
infusion or Fentanyl bolus. Esketamine in monotherapy was also effective.
Discussion: The drugs studied have an adverse effect profile compatible with safe pediatric
sedation, whether administered by a specialist or not. However, alternative administration
routes and dosages still need further studies before being routinely applied.
Conclusion: Sedation in pediatrics is still an open field for research in our country.
Keywords
deep sedation, dexmedetomidine, ketamine, pediatric anesthesia, propofol
