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Procedural Sedation — Determine Sedation Regimen — Clinical Pathway: Emergency Department

Procedural Sedation Clinical Pathway — Emergency Department

Determine Sedation Regimen

Goal is to provide least amount of medication and depth of sedation while achieving optimal patient comfort and safety. Medication regimens listed are reflective of the CHOP formulary and sedation guidelines.

Relatively short exposure to sedation medications in infants or toddlers is unlikely to have negative effects on behavior or learning. See FDA Drug Safety Communication  .

Consider appropriate sedation level

  • Minimal/Anxiolysis: Normal response to voice/touch
  • Moderate: Response to voice/touch
  • Deep: Response to deep painful stimuli

Sedation Regimen Recommendations

Indication for Sedation Procedure Examples Anxiolysis/Minimal Moderate Deep
Painless Procedure or Anxiety/Distress Imaging Midazolam Midazolam
Pentobarbital
Dexmedetomidine IN
Pentobarbital +/-
Midazolam
Propofol
Painful Procedure with Local/Regional Anesthesia Dental procedure
Fracture requiring hematoma block
Digit repair
Lumbar puncture
Laceration repair
Midazolam Midazolam with or without opioids
Ketamine PO
Dexmedetomidine IN
Ketamine IV/IM
Propofol
Painful Procedure Fracture reduction
Abscess
Chest tube
None Opioid and midazolam
Ketamine PO
Ketamine IV/IM

 

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