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Cardiovascular collapse can result from the myocardial depression produced from sedative drugs.

Such problems can occur suddenly, as patients can rapidly progress from one level of sedation to another.

Rather, patients are to be sedated and then continuously evaluated with respect to their actual (not intended) level of consciousness, presence or absence of protective reflexes, and response to painful stimuli.

Based on such continuous evaluation, the patient is described as being in one of the following states of sedation: 1) anxiolysis, 2) mild sedation, 3) moderate sedation, 4) deep sedation, 5) general anesthesia.

For this reason, it is important for all practitioners to understand the complexities of the sedation process, including the sedation safety standards, the issues addressed during the pre-sedation evaluation, the risks and benefits of some commonly used sedatives and analgesics, and the importance of the discharge process.

Practice guidelines from various organizations have been repeatedly revised in attempts to clarify the responsibilities of practitioners during sedation, to define the monitoring standards, and to develop consistent terminology to the sedation process.

Consequently, practitioners who sedate patients must be skilled in advanced airway management, pediatric advanced life support and in assessment of patients for changing levels of sedative effects.

Sedation can potentially cause hypoventilation or upper airway obstruction leading to hypoxemia and respiratory arrest.

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In most cases, regardless of the type of procedure, children are deeply sedated in order to provide adequate working conditions.

There is no such thing as “light sedation” or “twilight sleep” that will help a toddler stay immobile for a 2-hour magnetic resonance imaging (MRI) scan, help a child get through an upper endoscopy and colonoscopy, or enable a complex fracture to be set.

Administering sedatives to children to facilitate performing therapeutic or diagnostic procedures is a growing practice in hospital and outpatient settings.

Procedures for which sedatives are given include diagnostic imaging studies, laceration repair, foreign body removal, spinal taps, and orthopaedic procedures.

A collaborative effort by the American Academy of Pediatrics (AAP), American Society of Anesthesiologists (ASA), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has produced comprehensive standards for safe sedation practice.[1-4] The new guidelines stress that the level or score referring to the patient’s depth of sedation is independent of drug choice, route of administration, or the intended level of consciousness.

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