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Sedation for diagnostic and therapeutic procedures in children and

By Joann Roberts,2014-05-04 03:53
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Sedation for diagnostic and therapeutic procedures in children and

Issue date: December 2010

    Sedation in children and young people

    Sedation for diagnostic and therapeutic procedures in children and young people

    NICE clinical guideline 112 Sedation for diagnostic and therapeutic procedures in children and young people

Ordering information

    You can download the following documents from

    www.nice.org.uk/guidance/CG112

     The NICE guideline (this document) all the recommendations.

     A quick reference guide a summary of the recommendations for

    healthcare professionals.

     ‘Understanding NICE guidance’ – a summary for patients and carers.

     The full guideline all the recommendations, details of how they were

    developed, and reviews of the evidence they were based on.

    For printed copies of the quick reference guide or ‘Understanding NICE guidance’, phone NICE publications on 0845 003 7783 or email

    publications@nice.org.uk and quote:

     N2380 (quick reference guide)

     N2381 (‘Understanding NICE guidance’).

    NICE clinical guidelines are recommendations about the treatment and care of people with specific diseases and conditions in the NHS in England and Wales. This guidance represents the view of NICE, which was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, and informed by the summary of product characteristics of any drugs they are considering.

    Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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    www.nice.org.uk

    ? National Institute for Health and Clinical Excellence, 2010. All rights reserved. This material may be freely reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the express written permission of NICE.

    NICE clinical guideline 112 Sedation in children and young people

Contents

    Introduction ...................................................................................................... 4 Patient-centred care ......................................................................................... 7 Key priorities for implementation ...................................................................... 8 1 Guidance ................................................................................................. 11 1.1 Pre-sedation assessment, communication, patient information and

    consent ............................................................................................. 11 1.2 Fasting .............................................................................................. 12 1.3 Psychological preparation ................................................................. 13 1.4 Personnel and training ...................................................................... 14 1.5 Clinical environment and monitoring ................................................. 15 1.6 Discharge criteria .............................................................................. 17 1.7 Painless imaging ............................................................................... 17 1.8 Painful procedures ............................................................................ 18 1.9 Dental procedures............................................................................. 18 1.10 Endoscopy ........................................................................................ 19 2 Notes on the scope of the guidance ........................................................ 19 3 Implementation ........................................................................................ 19 4 Research recommendations .................................................................... 20 5 Other versions of this guideline ............................................................... 22 6 Related NICE guidance ........................................................................... 22 7 Updating the guideline ............................................................................. 22 Appendix A: The Guideline Development Group, National Clinical Guideline

    Centre and NICE project team ....................................................................... 24 Appendix B: The Guideline Review Panel...................................................... 27 Appendix C: The algorithms ........................................................................... 28 Appendix D: Licensing indications ................................................................. 29

    NHS Evidence has accredited the process used by the Centre for Clinical Practice at NICE to produce guidelines. Accreditation is valid for 3 years from April 2010 and is applicable to guidance produced using the processes described in NICE’s ‘The guidelines manual’ (2009). More information on accreditation can be viewed at www.evidence.nhs.uk

NICE clinical guideline 112 Sedation in children and young people

Introduction

    Advances in the treatment of paediatric diseases has led to an increase in the number of painful or distressing diagnostic or therapeutic procedures for which many children will need effective sedation or anaesthesia. The choice between sedation and anaesthesia will depend on the type of procedure. Some procedures are very common and healthcare providers and

    practitioners need to understand under which circumstances either sedation or anaesthesia is most cost effective.

    In adults, many procedures can be undertaken with local anaesthesia and reassurance. In children and young people this is often not possible because the procedures are too frightening, too painful or need to be carried out in children who may be ill, in pain or have behavioural problems. The aims of sedation during diagnostic or therapeutic procedures include reducing fear and anxiety, augmenting pain control and minimising movement. The importance of each of these aims will vary depending on the nature of the procedure and the characteristics of the patient.

    There are many sedation techniques available but there is insufficient guidance on which techniques are effective and what resources, including staff training, are required to deliver them safely.

    Sedation is not always effective enough and so occasionally the procedure has to be delayed until the child or young person can be anaesthetised. This may need to take place in a different healthcare setting or on another day. Consequently, sedation failure is distressing for the child or young person and also has major NHS cost implications.

    Excessive sedation can cause unintended loss of consciousness and dangerous hypoxia. Planned anaesthesia, in comparison, is effective but might have resource implications.

    NICE clinical guideline 112 Sedation in children and young people 4