Procedural sedation: A review of sedative agents, monitoring, and management of complications

Saudi Journal of Anaesthesia

Volumn 5, Issue 4, 2011, Pages 395-410

  Tobias, Joseph D ^a   Leder, Marc ^a  

^a NATIONWIDE CHILDREN S HOSPITAL   (United States)

Author keywords

Dexmedetomidine; ketamine; procedural sedation; propofol; respiratory depression

Indexed keywords

BENZODIAZEPINE DERIVATIVE; CARBON DIOXIDE; CHLORAL HYDRATE; CYCLOSPORIN; DEXMEDETOMIDINE; ETOMIDATE; FENTANYL; FLUMAZENIL; KETAMINE; METHOHEXITAL; METHYLXANTHINE; MIDAZOLAM; MONOAMINE OXIDASE INHIBITOR; MORPHINE; NALMEFENE; NALOXONE; NARAN; NITROUS OXIDE; OPIATE; OXYGEN; PETHIDINE; PHENOBARBITAL; PHENYTOIN; PROPOFOL; REMIFENTANIL; SEDATIVE AGENT; SUFENTANIL; THIAMYLAL; THIOPENTAL; TRICYCLIC ANTIDEPRESSANT AGENT; UNCLASSIFIED DRUG; UNINDEXED DRUG;

ADRENAL INSUFFICIENCY; AGGRESSION; ANALGESIA; APNEA; BISPECTRAL INDEX; BLOOD PRESSURE MONITORING; BONE MARROW SUPPRESSION; BRADYCARDIA; BREATHING RATE; CARDIOVASCULAR FUNCTION; CENTRAL NERVOUS SYSTEM DISEASE; CRYING; DIZZINESS; DRUG ABSORPTION; DRUG BIOAVAILABILITY; DRUG DOSE TITRATION; DRUG FATALITY; DRUG INDUCED HEADACHE; DRUG INTOXICATION; DRUG METABOLISM; DYSPHORIA; ELECTROCARDIOGRAPHY; ELECTROENCEPHALOGRAPHY; ELECTROMYOGRAPHY; HEART ARRHYTHMIA; HEART RATE; HUMAN; HYPERTENSION; HYPOTENSION; HYPOVENTILATION; LARYNX SPASM; LUNG EDEMA; MEAN ARTERIAL PRESSURE; MEGALOBLASTIC ANEMIA; NAUSEA; NAUSEA AND VOMITING; PATIENT MONITORING; PATIENT SAFETY; PEDIATRIC ADVANCED LIFE SUPPORT; PERIPHERAL NEUROPATHY; POSITIVE END EXPIRATORY PRESSURE; PRACTICE GUIDELINE; PREOPERATIVE EVALUATION; PRIORITY JOURNAL; PULSE OXIMETRY; RECOMMENDED DRUG DOSE; REFLEX DISORDER; RESPIRATION DEPRESSION; RESPIRATORY FUNCTION; RESTLESSNESS; RESUSCITATION; REVIEW; SEDATION; SEIZURE; SIDE EFFECT; TACHYCARDIA; THORAX WALL DEFECT; THORAX WALL RIGIDITY; TREMOR;

EID: 81755188313     PISSN: 1658354X     EISSN: 09753125     Source Type: Journal    
DOI: 10.4103/1658-354X.87270     Document Type: Review

References (81)

1. Malviya S, Voepel-Lewis T, Tait AR. Adverse events and risk factors associated with the sedation of children by non-anesthesiologists. Anesth Analg 1997;85:1207-13. (Pubitemid 28130512)
2. Hertzog JH, Campbell JK, Dalton HJ, Hauser GJ. Propofol anesthesia for invasive procedures in ambulatory and hospitalized children: Experience in the pediatric intensive care unit. Pediatrics 1999;103: e30.
3. Pomeranz ES, Chudnofsky CR, Deegan TJ, Lozon MM, Mitchiner JC, Weber JE. Rectal methohexital sedation for computed tomography imaging of stable pediatric emergency department patients. Pediatrics 2000;105:1110-4. (Pubitemid 30243792)
4. Litman RS. Conscious sedation with remifentanil and midazolam during brief painful procedures in children. Arch Pediatr Adolesc Med 1999;153:1085-8. (Pubitemid 29473466)
5. Satoh M, Minami M. Molecular pharmacology of the opioid receptors. Pharmacol Ther 1995;68:343-64. (Pubitemid 26020722)
6. Bailey PL, Pace NL, Ashburn MA, Moll JW, East KA, Stanley TH. Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology 1990;73:826-30. (Pubitemid 20380922)
7. Yaster M, Nichols DG, Deshpande JK, Wetzel RC. Midazolam-fentanyl intravenous sedation in children: Case report of respiratory arrest. Pediatrics 1990;86:463-7. (Pubitemid 20334983)
8. Fahnenstich H, Steffan J, Kau N, Bartmann P. Fentanyl-induced chest wall rigidity and laryngospasm in preterm and term infants. Crit Care Med 2000;28:835-9.
9. Muller P, Vogtmann C. Three cases with different presentation of fentanyl-induced muscle rigidity-a rare problem in intensive care of neonates. Am J Perinatol 2000;17:23-6. (Pubitemid 30452035)
10. Hershey LA. Meperidine and central neurotoxicity. Ann Intern Med 1983;98:548-9. (Pubitemid 13116632)
11. Da Silva O, Alexandrou D, Knoppert D, Young GB. Seizure and electroencephalographic changes in the newborn period induced by opiates and corrected by naloxone infusion. J Perinatol 1999;19:120-3.
12. De Armendi AJ, Fahey M, Ryan JF. Morphine-induced myoclonic movements in a pediatric pain patient. Anesth Analg 1993;77:191-2. (Pubitemid 23200983)
13. Scott JC, Sarnquist FH. Seizure-like movements during a fentanyl infusion with absence of seizure activity in a simultaneous EEG recording. Anesthesiology 1985;62:812-4. (Pubitemid 15064832)
14. Blair JM, Hill DA. Probable seizure after remifentanil in a 4-year-old boy. Anaesthesia 2000;55:501-3.
15. Grossmann M, Abiose A, Tangphao O, Blaschke TF, Hoffman BB. Morphine-induced venodilation in humans. Clin Pharmacol Ther 1996;60:554-60. (Pubitemid 26414091)
16. Sato A, Sato Y, Schmidt RF. Modulation of somatocardiac sympathetic reflexes mediated by opioid receptors at the spinal and brainstem level. Exp Brain Res 1995;105:1-6.
17. Harris CE, Grounds RM, Murray AM, Lumley J, Royston D, Morgan M. Propofol for long-term sedation in the intensive care unit. A comparison with papaveretum and midazolam. Anaesthesia 1990;45:366-72.
18. Beller JP, Pottecher T, Lugnier A Mangin P, Otteni JC. Prolonged sedation with propofol in ICU patients: Recovery and blood concentration changes during periodic interruption in infusion. Br J Anaesth 1988;61:583-8.
19. Hemelrijck JV, Fitch W, Mattheussen M, Van Aken H, Plets C, Lauwers T. Effect of propofol on cerebral circulation and autoregulation in the baboon. Anesth Analg 1990;71:49-54. (Pubitemid 20380569)
20. Nimkoff L, Quinn C, Silver P, Sagy M. The effects of intravenous anesthetic agents on intracranial pressure and cerebral perfusion pressure in two feline models of brain edema. J Crit Care 1997;12:132-6. (Pubitemid 27445406)
21. Kassam SI, Lu C, Buckley N, Lee RM. The mechanisms of propofol-induced vascular relaxation and modulation by perivascular adipose tissue and endothelium. Anesth Analg 2011;112:1339-45.
22. Tritapepe L, Voci P, Marino P, Cogliati AA, Rossi A, Bottari B, et al. Calcium chloride minimizes the hemodynamic effects of propofol in patients undergoing coronary artery bypass grafting. J Cardiothorac Vasc Anes 1999;13:150-3. (Pubitemid 29204939)
23. Scholal C, Van Deenen D, De Ville A, Govearts MJ. Heart block following propofol in a child. Paediatr Anaesth 1999;9:349-51. (Pubitemid 29307516)
24. Egan TD, Brock-Utne JG. Asystole and anesthesia induction with a fentanyl, propofol and succinylcholine sequence. Anesth Analg 1991;73:818-20.
25. Shah S, Shah S, Apuya J, Gopalakrishnan S, Martin T. Combination of oral ketamine and midazolam as a premedication for a severely autistic and combative patient. J Anesth 2009;23:126-8.
26. White PF, Ham J, Way WL, Trevor AJ. Pharmacology of ketamine isomers in surgical patients. Anesthesiology 1980;52:231-9. (Pubitemid 10176862)
27. Chernow B, Laker CR, Creuss D, Coyle J, Hughes P, Balestrieri F, et al. Plasma, urine, and cerebrospinal fluid catecholamine concentration during and after ketamine sedation. Crit Care Med 1982;10:600-3.
28. Wayman K, Shoemaker WC, Lippmann M. Cardiovascular effects of anesthetic induction with ketamine. Anesth Analg 1980;59:355-8. (Pubitemid 10102693)
29. Spotoft H, Korshin JD, Sorensen MB, Skovsted P. The cardiovascular effects of ketamine used for induction of anesthesia in patients with valvular heart disease. Can Anesth Soc J 1979;26:463-7. (Pubitemid 10140417)
30. Gooding JM, Dimick AR, Travakoli M, Corssen G. A physiologic analysis of cardiopulmonary responses to ketamine anesthesia in non-cardiac patients. Anesth Analg 1977;56;813-6. (Pubitemid 8235813)
31. Fleischer F, Polarz H, Lang J, Bohrer H. Changes in oxygen saturation following low-dose intramuscular ketamine in pediatric cardiac surgical patients. Paediatric Anaesthesia 1991;1:33-6.
32. Mankikain B, Cantineau JP, Sartene R, Clergue F, Viars P. Ventilatory and chest wall mechanics during ketamineb anesthesia in humans. Anesthesiology 1986;65:492-9. (Pubitemid 17200389)
33. Hirshman CA, Downes H, Farbood A, Bergman NA. Ketamine block of bronchospasm in experimental canine asthma. Br J Anaesth 1979;51:713-8. (Pubitemid 10249371)
34. Bourke DL, Malit LA, Smith TC. Respiratory interactions of ketamine and morphine. Anesthesiology 1987;66:153-6. (Pubitemid 17014444)
35. Lanning CF, Harmel MH. Ketamine anesthesia. Annu Rev Med 1975;26:137-41.
36. Taylor PA, Towey RM. Depression of laryngeal reflexes during ketamine administration. Br Med J 1971;2:688-9.
37. Cohen VG, Krauss B. Recurrent episodes of intractable laryngospasm during dissociative sedation with intramuscular ketamine. Pediatr Emerg Care 2006;22:247-9. (Pubitemid 43772175)
38. Melendez E, Bachur RP. Serious adverse events during procedural sedation with ketamine. Pediatr Emerg Care 2009;25:325-8.
39. Himmelseher S, Durieux ME. Revising a dogma: Ketamine for patients with neurological injury? Anesth Analg 2005;101:524-34.
40. Brown L, Christian-Kopp S, Sherwin TS, Khan A, Barcega B, Denmark TK, et al. Adjunctive atropine is unnecessary during ketamine sedation in children. Acad Emerg Med 2008;15:314-8.
41. Walthen JE, Roback MG, Mackenzie T, Bothner JP. Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double-blind, randomized controlled, emergency department trial. Ann Emerg Med 2000;36:579-88.
42. Van de Wiele B, Rubinstein E, Peacock W, Martin N. Propylene glycol toxicity caused by prolonged etomidate infusion. J Neurosurg Anesthesiol 1995;7:259-62.
43. Belelli D, Pistis M, Peters JA, Lambert JJ. The interaction of general anesthetics and neurosteroids with GABAA and glycine receptors. Neurochem Int 1999;34:447-52. (Pubitemid 29240641)
44. Giese JL, Stockham RJ, Stanley TH, Pace NL, Nelissen RH. Etomidate versus thiopental for induction of anesthesia.Anesth Analg 1985;64:871-6.
45. Brussel T, Theissen JL, Vigfusson G, Lunkenheimer PP, Van Aken H, Lawin P. Hemodynamic and cardiodynamic effects of propofol and etomidate: Negative inotropic properties of propofol. Anesth Analg 1989;69:35-40. (Pubitemid 20037061)
46. Wagner RL, White PF, Kan PB, Rosenthal MH, Feldman D. Inhibition of adrenal steroidogenesis by the anesthetic etomidate. N Engl J Med 1984;310:1415-21. (Pubitemid 14101296)
47. Absalom A, Pledger D, Konig A. Adrenocortical function in critically ill patients 24 hours after a single dose of etomidate. Anaesthesia 1999;54:861-7. (Pubitemid 29415418)
48. Cotton BA, Guillamondegui OD, Fleming SB, Carpenter RO, Patel SH, Morris JA Jr, et al. Increased risk of adrenal insufficiency following etomidate exposure in critically injured patients. Arch Surg 2008;143:62-7. (Pubitemid 351159292)
49. Vinson DR, Bradbury DR. Etomidate for procedural sedation in emergency medicine. Ann Emerg Med 2002;39:592-8. (Pubitemid 34596051)
50. Rubin JT, Towbin RB, Bartko M, Baskin KM, Cahill AM, Kaye RD. Oral and intravenous caffeine for treatment of children with post-sedation paradoxical hyperactivity. Pediatr Rad 2004;34:980-4. (Pubitemid 39562343)
51. Holst JJ. Use of nitrous oxide-oxygen analgesia in dentistry. Int Dent J 1962;12:47-51.
52. Griffin GC, Campbell VD, Joni R. Nitrous oxide-oxygen sedation for minor surgery: Experience in a pediatric setting. JAMA 1981;245:2411-4.
53. Litman RS, Berkowitz RJ, Ward DS. Levels of consciousness and ventilatory parameters in young children during sedation with oral midazolam and nitrous oxide. Arch Pediatr Adolesc Med 1996;150:671-5. (Pubitemid 26230863)
54. Zier JL, Drake GJ, McCormick PC, Clinch KM, Cornfield DN. Case-series of nurse-administered nitrous oxide for urinary catheterization in children. Anesth Analg 2007;104:876-9. (Pubitemid 46548314)
55. Babl FE, Oakley E, Puspitadewi A, Sharwood LN. Limited analgesic efficacy of nitrous oxide for painful procedures in children. Emerg Med J 2008;25:717-21.
56. Mayers DJ, Hindmarsh KW, Sankaran K, Gorecki DK, Kasian GF. Chloral hydrate disposition following single-dose administration to critically ill neonates and children. Dev Pharmacol Ther 1992;19:141-6.
57. Graham SR, Day RO, Lee R, Fulde GW. Overdose with chloral hydrate: A pharmacological and therapeutic review. Med J Aust 1988;149:686-8. (Pubitemid 19023438)
58. Seger D, Schwartz G. Chloral hydrate: A dangerous sedative for overdose patients. Pediatri Emerg Care 1994;10:349-50.
59. Coté CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: Analysis of medications used for sedation. Pediatrics 2000;106:633-44.
60. Doyle WL, Perrin L. Emergence delirium in a child given oral midazolam for conscious sedation. Ann Emerg Med 1994;24:1173-5. (Pubitemid 24368160)
61. Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia 1999;54:1136-42.
62. Talke P, Chen R, Thomas B, Aggarwall A, Gottlieb A, Thorborg P, et al. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg 2000;90:834-9. (Pubitemid 30190786)
63. Berkenbosch JW, Tobias JD. Development of bradycardia during sedation with dexmedetomidine in an infant concurrently receiving digoxin. Pediatr Crit Care Med 2003;4:203-5.
64. Hall JE, Uhrick TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000;90:699-705. (Pubitemid 30117535)
65. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans: I Sedation, ventilation and metabolic rate. Anesthesiology1992;77:1125-33. (Pubitemid 23001123)
66. Guidelines for the elective use of conscious sedation, deep sedation, and general anesthesia in pediatric patients, Committee on Drugs, Section on Anesthesiology. Pediatrics 1985;76:317-21.
67. American Academy of Pediatrics, Committee on Drugs: Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. Pediatrics 1992;89:1110-5.
68. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: An update. Pediatrics 2006;118:2587-602.
69. Practice guidelines for sedation and analgesia by non-anesthesiologists: A report by the American Society of Anesthesiologists Task Force on sedation and analgesia by non-anesthesiologists. Anesthesiology 1996;84:459-71.
70. Moyle JT. Uses and abuses of pulse oximetry. Arch Dis Child 1996;74:77-80. (Pubitemid 26039961)
71. Malviya S, Reynolds PI, Voepel-Lewis T, Siewert M, Watson D, Tait AR, et al. False alarms and sensitivity of conventional pulse oximetry versus the Masimo SET™ technology in the pediatric postanesthetic care unit. Anesth Analg 2000;90:1336-40. (Pubitemid 30351332)
72. Mannheimer PD, Bebout DE. The OxiMax system: Nellcor's new platform for oximetry. Minerva Anestesiol 2002;68:236-9. (Pubitemid 41750853)
73. 2 monitoring when comparing three methods of conscious sedation for children undergoing painful procedures in the emergency department. Pediatr Emerg Care 1997;13:189-93. (Pubitemid 27284145)
74. Tobias JD. End-tidal carbon dioxide monitoring during sedation with a combination of midazolam and ketamine for children undergoing painful, invasive procedures. Pediatr Emerg Care 1999;15:173-5. (Pubitemid 29268980)
75. Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, et al. Validity and reliability of the observer's assessment of alertness/sedation scale: Study with intravenous midazolam. J Clin Psychopharmacol 1990;10:244-51. (Pubitemid 20319177)
76. Macnab AJ, Levine M, Glick N, Susak L, Baker-Brown G. A research tool for measurement of recovery from sedation: The Vancouver Sedative Recovery Scale. J Pediatr Surg 1991;26:1263-7.
77. Malviya S, Voepel-Lewis T, Tait AR, Merkel S, Tremper K, Naughton N. Depth of sedation in children undergoing computed tomography: Validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth 2002;88:241-5. (Pubitemid 34145002)
78. Gill M, Green SM, Krauss B. A study of the Bispectral Index Monitor during procedural sedation and analgesia in the emergency department. Ann Emerg Med 2003;41:234-41. (Pubitemid 36158020)
79. McDermott NB, VanSickle T, Motas D, Friesen RH. Validation of the Bispectral Index monitor during conscious and deep sedation in children. Anesth Analg 2003;97:39-43. (Pubitemid 36736535)
80. Motas D, McDermott NB, VanSickle T, Friesen RH. Depth of consciousness and deep sedation attained in children as administered by nonanesthesiologists in a children's hospital. Pediatr Anesth 2004;14:256-60. (Pubitemid 38373063)
81. Davidson AJ, Kim MJ, Sangolt GK. Entropy and bispectral index during anaesthesia in children. Anaesth Intensive Care 2004;32:485-93. (Pubitemid 39172453)