Procedural Sedation 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 |