Key priorities for implementation

Key priorities for implementation

Pre‑sedation assessment, communication, patient information and consent

  • Ensure that trained healthcare professionals (see section 1.4) carry out pre‑sedation assessments and document the results in the healthcare record.

  • Establish suitability for sedation by assessing all of the following:

    • current medical condition and any surgical problems

    • weight (growth assessment)

    • past medical problems (including any associated with previous sedation or anaesthesia)

    • current and previous medication (including any allergies)

    • physical status (including the airway)

    • psychological and developmental status.

  • Seek advice from a specialist before delivering sedation:

    • if there is concern about a potential airway or breathing problem

    • if the child or young person is assessed as American Society of Anesthesiologists (ASA) grade 3[1] or greater

    • for infants, including neonates.

  • Ensure that both the following will be available during sedation:

    • a healthcare professional and assistant trained (see section 1.4) in delivering and monitoring sedation in children and young people

    • immediate access to resuscitation and monitoring equipment (see section 1.5).

  • Choose the most suitable sedation technique based on all the following factors:

    • what the procedure involves

    • target level of sedation

    • contraindications

    • side effects

    • patient (or parent or carer) preference.

Personnel and training

  • Healthcare professionals delivering sedation should have knowledge and understanding of and competency in:

    • sedation drug pharmacology and applied physiology

    • assessment of children and young people

    • monitoring

    • recovery care

    • complications and their immediate management, including paediatric
      life support.

  • Healthcare professionals delivering sedation should have practical experience of:

    • effectively delivering the chosen sedation technique and managing complications

    • observing clinical signs (for example, airway patency, breathing rate and depth, pulse, pallor and cyanosis, and depth of sedation)

    • using monitoring equipment.

  • Ensure that members of the sedation team have the following life support skills:

Minimal sedation a

Moderate sedation

Deep sedation

All members

Basic

Basic

Basic

At least one member

Intermediate

Advanced

a including sedation with nitrous oxide alone (in oxygen) and conscious sedation in dentistry.

  • Healthcare professionals delivering sedation should have documented up‑to‑date evidence of competency including:

    • satisfactory completion of a theoretical training course covering the principles of sedation practice

    • a comprehensive record of practical experience of sedation techniques, including details of:

      • sedation in children and young people performed under supervision

      • successful completion of work‑based assessments.

Clinical environment and monitoring

  • For deep sedation continuously monitor, interpret and respond[2] to all of the following:

    • depth of sedation

    • respiration

    • oxygen saturation

    • heart rate

    • three‑lead electrocardiogram

    • end tidal CO2 (capnography)[3]

    • blood pressure (monitor every 5 minutes)[3]

    • pain

    • coping

    • distress.



[1] The ASA physical status classification system (grades 1–6) is a system to classify and grade a patient's physical status before anaesthesia.

[2] For deep sedation, the healthcare professional administering sedation should be involved only in continuously monitoring, interpreting and responding to all of the above.

[3] End tidal CO2 and blood pressure should be monitored, if possible, provided that monitoring does not cause the patient to awaken and so prevent completion of the procedure.

  • National Institute for Health and Care Excellence (NICE)