Procedural Sedation — Pre-sedation Evaluation — Clinical Pathway: Emergency Department

Procedural Sedation Clinical Pathway — Emergency Department

Pre-sedation Evaluation

Consider child life consultation.

Pre-sedation Evaluation
  • PMH
    • Medications
    • Allergies
    • Medical co-morbidities
    • History of complications with prior sedation or anesthesia
  • Recent illness
  • Family history of malignant hyperthermia
  • Last PO intake solids, liquids, NPO status
  • Physical exam with emphasis on airway/heart/lungs
    • For American Society of Anesthesiologists (ASA) physical status (PS) classifications, see table below.
  • Pregnancy screening: females > 12 years old or < 12 years old that have experienced menarche
    • Many medications used for sedation have implications for a fetus. See Policy: Pregnancy Screening Guidelines for the ED
    • If a patient is pregnant and requires sedation for a non-life or limb threatening problem transfer patient to the Hospital of the University of Pennsylvania. If patient is pregnant and requires emergent sedation, consult anesthesia.

ASA Physical Status Classifications

ASA PS Classification Definition Pediatric Examples
ASA I Healthy child  
ASA II Child with mild systemic disease Child with history of asthma, not an acute exacerbation
ASA III Child with severe systemic disease or involving multiple systems
May require anesthesia consult prior to sedation		 Child with history of asthma with an acute exacerbation

Type 1 diabetes (involves multiple systems)
ASA IV Child with severe systemic disease that is a persistent threat to life
Requires anesthesia consult prior to sedation		 Child with history of hypoplastic left heart status post palliative shunt
ASA V Moribund child who is not expected to survive without the operation
Requires anesthesia consult prior to sedation		 Heart failure requiring transplant
ASA VI Declared brain-dead child whose organs are being removed for donor purposes  

ASA Physical Status Classifications