Go or No Go: Pediatric Pre-sedation Assessment

Preparation and Consideration in Special Populations

Details in Audio; Topics Covered:

Asthma and Reactive Airway Disease

Autism, Developmental Delay, and Intellectual Disability

Cannabis Use

Cerebral Palsy

Congenital Heart Disease

Cystic Fibrosis

Diabetes Mellitus

Endocrinopathies

Mitochondrial Disease

Muscular Dystrophies

Obstructive Sleep Apnea

Premature Infant

Sickle Cell Disease

Syndromes

Upper Respiratory Tract Infection

STOP BANG Questionnaire — Adult (one point each)

Snoring — Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?

Tired — Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during driving or talking to someone)?

Observed apnea — Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep ?

Pressure — Do you have or are being treated for High Blood Pressure ?

BMI — Body Mass Index more than 35 kg/m2?

Age — Age older than 50?

Neck circumference — Is your shirt collar 16 inches / 40cm or larger?

Gender — Male?

OSA – Low Risk: Yes to 0 – 2 questions
OSA – Intermediate Risk: Yes to 3 – 4 questions
OSA – High Risk: Yes to 5 – 8 questions

Teen STOP BANG Questionnaire (one point each)

Snoring — Does your child snore?

Tired — Is your child tired or sleepy during the day?

Observed — Does your child stop breathing during sleep?

Pressure — BP ≥ 95th percentile for age and height?

BMI — Body Mass Index ≥ 95th percentile for age?

Academic — Does your child have trouble in school?

Neck — Circumference ≥ 95th percentile for age?

Gender — Male?

OSA – Low Risk: Yes to 0 – 2 questions
OSA – Intermediate Risk: Yes to 3 – 4 questions
OSA – High Risk: Yes to 5 – 8 questions

American College of Emergency Physicians — Clinical Policy on Procedural Sedation

American College of Emergency Physicians — Fasting Guidelines 

Green et al. Fasting and emergency department procedural sedation and analgesia: a consensus-based clinical practice advisory. Ann Emerg Med. 2007 Apr;49(4):454-61.

Bottom Line: 

“Do not delay procedural sedation in adults or pediatrics in the ED based on fasting time. Preprocedural fasting for any duration has not demonstrated a reduction in the risk of emesis or aspiration when administering procedural sedation and analgesia.” (Level B Recommendation)

COLDS Score (for OR use)

References

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