SCOPE OF THE PROBLEM

In virtually all areas of medicine, including pediatrics, the use of advanced diagnostic imaging has increased substantially. Although utilization of all imaging modalities has increased, the use of computed tomography (CT) has grown at a particularly brisk rate, specifically in the evaluation and management of the trauma patient.

These increases have implications for physicians in the emergency department (ED) as procedural sedation is frequently required to calm and immobilize a child for these studies. It may be possible to perform many procedures utilizing behavioral or distraction techniques, obviating the need for procedural sedation. However, the stressful, frightening nature of an injury or ED environment often requires moderate to deep sedation to overcome these factors and achieve diagnostic imaging goals.

CLINICAL ASSESSMENT

Prior to the administration of any sedative agent, a careful preprocedure assessment should be undertaken. Special attention should be given to historical features that may complicate procedural sedation including a past history of adverse events with sedation or anesthesia, medication history, and medication allergies. The history should also evaluate the patient for seizure potential and/or the likelihood of a neurological injury/condition that may result in elevated intracranial pressures, as these considerations will be of importance in the consideration for the appropriateness of ketamine.

The guidelines of the American Society of Anesthesiology recommend delaying sedation for at least 2–3 hr after the last clear liquids and 4–8 hr after solids or milk.