Outpatient Procedural Sedation and Analgesia (Children)

Our hospital has adopted procedural sedation as a standard protocol for young patients who are undergoing procedures that require the child to keep still. This practice is considered to be very safe.

In procedural sedation, medicines are used to sedate children who need to undergo short and/or painful hospital procedures. These include:

• Bone marrow aspiration
• Cardiac scan
• Diagnostic imaging scans such as CT scan, MRI scan and Nuclear Medicine study
  
• Electroencephalogram (EEG)
• Extensive dressing
• Hearing test
• Lumbar Puncture (Spinal fluid aspiration)

The sedative may be administered orally or through injection. These procedures are performed under PSA in the outpatient clinics, hence your child may not need an admission. In painful procedures, analgesic (painkillers) and/or local anaesthetic medications are also prescribed. After the procedure, mild pain can be relieved by oral medication (eg. Paracetamol). He/she will be monitored closely throughout the procedure.

Commonly used drugs are:

• Chloral Hydrate
• Ketamine
• Midazolam
  
  

Side effects of the medicines used for PSA include:

• Nausea and vomiting
• Rashes
• Diarrhoea
• Agitation or euphoria
• Respiratory depression
• Hypotension
  

Most side effects are self-limiting and usually resolve after one to two hours, or after treatment.

It is rare for the child to develop a bad allergic reaction to the medicines used in PSA. Appropriate and prompt treatment will be instituted if it occurs.

Yes. A minimum of three hours of fasting is necessary before the appointment time, or as instructed by the doctor or nurse. MRI scan will require a fasting of 6 hours.

• Ensure that the last meal is light: plain milk (maximum one cup) with plain biscuits or plain bread (maximum two pieces).
• Heavy oily meals can cause child to vomit, potentially leading to food entering the lungs and causing life-threatening complications. This is because heavy oily meals tend to stay longer in the stomach and increase the risk of vomiting.
  

• Patients with known allergy to the medicine used for PSA
• Patients who have taken a meal less than three hours before PSA
• Patients with an ongoing respiratory tract infection
• Patients with unstable medical disease
  
  

No. We will reschedule another appointment in 2 weeks’ time after recovery from the acute illness.

• Supervise your child at all times for the next four hours after procedure.
  
  

• Avoid activities such as riding a bicycle, scooter or skateboard.
• Avoid giving your child medications which cause drowsiness.
• Supervise your child when he/she is placed in the car seat to prevent their head from flopping forward during the car journey, which may cause the tongue to obstruct his/her breathing
  
  

You should bring your child to the Children's Emergency at Children's Tower, Basement 1 in the following situations:

• If your child remains drowsy or feels unwell.
• In severe pain despite taking painkillers
  
  

For outpatient appointments, please arrive 45 minutes before the procedure time for:

• Registration
• Administration of sedation
  
  

As consent for procedural sedation is required, a parent/legal guardian should accompany the child for the procedure. Bring along a favourite toy/pillow and other necessities such as adequate milk powder and diapers.

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