Tailoring Pediatric Procedural Sedation and Analgesia in the Emergency Department: Choosing a Regimen to Fit the Situation

Practitioners of procedural sedation and analgesia for children in an emergency department setting must balance the needs of individual patients, including safety and efficacy, with the needs of the department as a whole, including efficiency and appropriate use of resources. Individual patient needs will vary depending on the age and developmental stage of the patient, the anticipated level of pain and distress, the degree of immobility required, and the duration of the procedure. The ability to accurately predict the need for sedation, the level of sedation and degree of analgesia required for patient comfort, and the best sedative agent to accomplish these goals without undesirable consequences is a skill that requires knowledge and experience. This review presents 6 case scenarios illustrating various sedation options, from an evidence-based perspective whenever possible, for common pediatric presenting complaints.