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Pediatric Sedation: Monitoring

Sedation for pediatric procedures may be requested both inside and outside of the operating room and can range from anxiolysis to general anesthesia. Careful patient monitoring is crucial to prevent and/or detect common problems encountered while administering sedation. Monitoring for the pediatric population is largely similar to that of adults and anesthesiologists should continue to choose monitors and alarm limits that are appropriate for each individual case. Common monitors and some special pediatric considerations include:

  • Electrocardiogram- Measures heart rate and detects adverse rhythms. Patient may require pediatric sized electrode pads.
  • Noninvasive Blood Pressure- Has been confirmed to be reliable in pediatric population.
  • Pulse Oximetry- Neonates should have probe placed on RIGHT hand or earlobe to ensure pre-ductal measurements
  • Capnography- Hypoxia is a common cause of perioperative morbidity and mortality in the pediatric population. Measuring end-tidal CO2 allows for assessment of ventilation, cardiac output, ETT placement, etc.
  • Temperature- Pediatric patients are at greater risk of malignant hyperthermia and are more susceptible to intraoperative hypo/hyperthermia. Measures should be taken to maintain a warm operating environment and include warming/humidifying inspired gases and IV fluids, warming blankets/lights, and keeping OR temp 26 oC or warmer.

Invasive monitors such as arterial and central venous catheters should be included on a case-by-case basis. Special consideration should be given to the unique circulation of the neonatal population when choosing line placement. Precordial/esophageal stethoscopes can be used to easily measure heart rate/sounds and airway patency but are not required.