COMPARATIVE REVIEW OF THE ADVERSE-EFFECTS OF SEDATIVES USED IN CHILDREN UNDERGOING OUTPATIENT PROCEDURES

Children often fear medical procedures and interventions. Sedative age nts enhance the care of these children who undergo outpatient procedur es by decreasing anxiety, increasing cooperativity, and providing amne sia. Although higher dosages and intravenous administration of sedativ es often produce improved sedation, adverse effects and complications are more frequent. The goals of therapeutic efficacy and safety must b e balanced in all patients. The presence or anticipation of anxiety an d pain helps in deciding whether to use a sedative alone, or a regimen also providing analgesia. The patient's clinical cardiorespiratory or neurological status, other relative contraindications, the duration o f the intended procedure, and the presence or absence of an intravenou s line will help in choosing specific drugs. Drug complications are a common cause of adverse events in patients. The combination of a sedat ive and analgesic, especially a benzodiazepine and an opioid given int ravenously, is associated with a higher risk of serious complications. The practitioner responsible for the administration of a sedative to a child must be competent in its use and have the ability to detect an d manage complications. Patients who are deeply sedated should be cont inuously monitored and observed by an individual dedicated to this tas k. Vital signs and oxygen saturation should be documented at frequent intervals and the patient should be appropriately monitored until disc harge criteria have been met. The risk of serious complications with t hese agents may be reduced with vigorous monitoring and a judicious ch oice of dosage.