The myth of conscious sedation

Article Abstract:

The idea that children can be maintained at a level of conscious sedation is a myth. The American Academy of Pediatrics distinguishes three levels of sedation: conscious, deep, and general anesthesia. The latter two require additional personnel and monitoring equipment because the child cannot maintain an open airway. Medical caregivers tend to call all sedation "conscious sedation" because this monitoring equipment and the extra personnel cost more. However, children sedated deeply enough to lie still under painful stimulus are deeply sedated, and the level of sedation cannot be predicted ahead of time in any given patient.

Editorial, Usage

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Levels of consciousness and ventilatory parameters in young children during sedation with oral midazolam and nitrous oxide

Article Abstract:

Some children sedated with a combination of oral midazolam hydrochloride and inhaled nitrous oxide may be deeply sedated while others may not be sedated at all. Deeply sedated children require extra personnel and monitoring to ensure an open airway and satisfactory oxygenation. Twenty children aged one to three having outpatient surgery were premedicated with oral midazolam and inhalation of one of four concentrations of nitrous oxide. As the concentration of nitrous oxide rose, the number of children not achieving sedation fell from 12 to 6 while the number of deeply sedated children rose from 0 to seven.

Physiological aspects, Nitrous oxide, Midazolam

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Conscious Sedation With Remifentanil and Midazolam During Brief Painful Procedures in Children

Article Abstract:

The sedative remifentanil combined with midazolam can be effective in sedating children for short periods of time but it has serious side effects. Remifentanil is a short-acting opioid drug. In a study of 17 children who received remifentanil and midazolam, the drug was very effective in sedating the child during short painful procedures. However, four children developed low blood oxygen levels and another child became unconscious and had to be placed on a ventilator. Opioids are known to suppress the respiratory system and this may limit the usefulness of remifentanil.

Health aspects, Care and treatment, Evaluation, Children, Opioids, Sedatives, Hypnotics and sedatives

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