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Please note: The information presented in the replies below does not represent SAMBA policy. The replies are solely the opinions of the individuals who wrote them.

Intraoperative Management/Are there guidelines for choloral hydrate administration for sedation for children?

QUESTION:

I am a non-physician quality administrator working with a pediatric task force in a mid west hospital. Several questions have come up that I thought I would pose to your group: What does the SAMBA &/or ASA say about administration of chloral hydrate to pediatric patients for the purposes of sedation during or prior to OP procedures?  Are there guidelines which address specific agents like chloral hydrate for the purposes of sedation and what do their guidelines look like?

-- From Steven C. Thayer, Grand Rapids, MI 

REPLY:

The ASA and SAMBA have no policy statements or guidelines concerning the use of specific sedatives such as chloral hydrate. However, the ASA and the American Academy of Pediatrics both have guidelines that govern the administration of sedatives to children. These guidelines are based on the intended level of sedation, and focus on the types of personnel that must be present, and the types of safety monitoring. In general, there are 3 levels of altered consciousness: moderate sedation, deep sedation, and general anesthesia. If one chooses to sedate a child, then they have to be prepared to rescue that child from a level of consciousness beyond that intended. The most common scenario being the intention of moderate sedation, with the credentials for rescuing a child from deep sedation.

For further information please see the following:

1. Committee on Drugs, American Academy of Pediatrics: Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. Pediatrics 1992; 89: 1110-1115
2. American Society of Anesthesiologists, Task Force on Sedation and Analgesia by Non-Anesthesiologists: Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 1996; 84: 459-471
3. http://www.jcaho.org/accredited+organizations/ambulatory+care/standards/

-- From Ron Litman, D.O., Merion Station, PA

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