Emergency Department Clinical Pathway
for Procedural Sedation

Sedation Procedure
Time out
Monitor child
Recover Child
Phase 1 recovery
Phase 2 recovery
  • Indications for Admission
  • Sedation related:
    • < 28 days (FT)
    • < 60 wks post-conceptual age
    • Need for further monitoring
  • Other medical/surgical reason for admission
Anesthesia Consult
  • ASA 4/5
  • Known or suspected difficult airway based on exam or syndrome, history of or active airway obstruction (severe OSA, active croup)
  • Clinical concern for increased intracranial pressure with urgent procedure
  • Ongoing emesis
Consider Anesthesia Consult
  • ASA 3
  • Age less than 1 yr
  • Chronic lung disease
  • C-collar in place
  • Impending OR for other procedure
  • Status epilepticus or poorly controlled seizure disorder
  • Acute asthma exacerbation requiring frequent bronchodilators
  • Severe autism/behavioral issues
  • Resource requirement
  • Complexity of procedure, pain, amount of sedation medication required
  • Impaired GI motility syndromes
Cardiology Consult
  • Review last Cardiology Clinic note
  • Examples that are appropriate for ED sedation
    • Repaired isolated PDA, ASD, VSD, coarctation with no hemodynamic or electrophysiologic compromise
  • For all other cardiac patients requiring procedural sedation, consult Cardiology or Cardiac Anesthesia as clinically indicated
Posted: July 2020
Revised: October 2023
Editors: Clinical Pathways Team