Foreword
Our aim with these guidelines is to provide a reference for safe sedation practice for all healthcare providers who are involved in paediatric sedation. Paediatric sedation outside of the operating theatre remains a controversial issue. There are safety concerns regarding the intravenous administration of drugs in children, especially when a combination of drugs is used. It is well known that whe
Our aim with these guidelines is to provide a reference for safe sedation practice for all healthcare providers who are involved in paediatric sedation. Paediatric sedation outside of the operating theatre remains a controversial issue. There are safety concerns regarding the intravenous administration of drugs in children, especially when a combination of drugs is used. It is well known that when more drugs are administered, there is a higher possibility of adverse events.
This edition of these guidelines gives guidance on how to do paediatric sedation safely. These guidelines also give information regarding the drugs that can be used for sedation. There is, however, no advice on paediatric sedation techniques. This must be learnt through supervised clinical training. We support international opinion that sedation practitioners doing paediatric sedation must be trained, have experience in sedation techniques and the necessary qualifications as stipulated in these guidelines.
Monitoring remains an important issue as far as paediatric sedation is concerned. There are clinicians that feel capnography must become part of the minimum monitoring standards, as it is believed to be a more sensitive monitor to alveolar hypoventilation than pulse oximetry. This is a valid argument for sedation in children where respiratory compromise is an important cause of morbidity. Many procedures are performed on children outside of a hospital, in facilities such as procedure rooms, which further emphasises capnography as a valuable monitoring method. Therefore, we highly recommend the use of capnography to monitor ventilation where available.
We want to emphasise again that procedures performed outside of a hospital operating theatre should only be for children with an ASA I or ASA II classification. Furthermore, the duration of an operation is also a consideration when the ASA classification is used. Children with ASA III or ASA IV classifications should only be operated on in a hospital operating theatre.
Accreditation is an important part of safe sedation practice and the accreditation of facilities where sedation is undertaken remains an important issue and needs to be addressed urgently. We emphasise again that it is unacceptable for sedation facilities to not meet the requirements of safe sedation practice. This issue is also addressed at international level and South Africa needs to follow suit. The facilities where we work, especially outside of operating theatres, must meet the requirements for safe practice. It is our responsibility to see that this is the case. Appendix 2 gives a practice appraisal protocol (PAP) that should be completed by sedation practitioners performing sedation procedures outside of a hospital operating theatre. You can contact the Society of Sedation Practitioners of South Africa (SOSPOSA) for more information on this issue.
The appendices have been revised with more information on what patients need to know about sedation (e.g. a sample of a cover letter to the patient which includes information to the patient, as well as information from the patient).
We have had difficult times and are still threatened by COVID-19. Therefore, we include information on the management of COVID-19 and the impact it may have on procedural sedation.
We wish all our readers a safe sedation journey.
Professor James Roelofse
jar@sun.ac.za
Dr Mari Jansen van Rensburg
mjvr@doctors.org.uk
Dr Rebecca Gray
rebecca.gray@uct.ac.za
Dr Cherese Lapere
cherese.lapere@gmail.com
SASA Paediatric Sedation Guidelines 2021 (South African Society of Anaesthesiologists)
Guidelines for the safe use of procedural sedation and analgesia for diagnostic and therapeutic procedures in children: 2021–2026
All healthcare professionals involved in the administration of sedation and participating in the assessment, monitoring and recovery of children requiring procedural sedation and analgesia (PSA) are accountable for safe practice. The child is entitled to the same standard of care, whether the procedure is undertaken outside the hospital (primary care), in a physician’s office, dental surgery, a remote facility or in an operating theatre.
The new guidelines replace the SASA Paediatric Sedation Guidelines 2016, Guidelines for the safe use of procedural sedation and analgesia for diagnostic and therapeutic procedures in children.
https://journals.co.za/doi/10.36303/SAJAA.2021.27.4.S2.2635
SASA Paediatric Guidelines for the Safe use of Procedural Sedation and Analgesia for Diagnostic and Therapeutic Procedures in Children: 2021–2026