Sedation Policy

                       

Patients will have pre-medication administered to assist with completion of relatively short,

pain free diagnostic tests and/or procedures (such as CAT scan, ultrasonography, EEG,

limited MRI).  This policy is not intended for use for patients requiring conscious sedation

(see Administrative Policy & Procedure PC:0017).

 

Patients excluded from this policy include the following:

 

  • Patients with significant upper/lower airway disease causing respiratory compromise
  • Patient with unstable cardiovascular status
  • Patients with neurologic instability
  • Patients with a prior history of anesthesia/sedation adverse reactions

 

 

SCOPE:   Registered nurses, licensed practical nurses, nursing assistants, medical staff

 

KEYWORDS:  Pre-medication

 

PROCEDURE:

 

A. Patient will have baseline weight (in kilograms), heart rate, blood pressure and pulse

oximetry taken and recorded prior to administration of pre-medication.   These values   must be within normal limits.

 

B. The proper dose of pre-medication will be administered and recorded as per nursing

    policy.  Noted problems related to administration (vomiting, spitting up, refusal) will be

   documented and the ordering physician made aware.

 

   The following recommended starting and follow-up doses are recommended. These doses

   are meant to be guidelines and may vary per individual patient and ordering  physician.

 

 

   Medication                          Initial Dose                             Subsequent Dose

 

   Chloral Hydrate                    75mg/kg PO/PR                     25mg/kg PO/PR after

                                                                                                30-45 minutes

 

   Secobarbital                          3mg/kg IM                             2mg/kg IM after

30- 45 minutes

 

Pentobarbital                         5mg/kg/IM                             1mg/kg IM after 30- 45

                                                                                             minutes

                                                 

   Midazolam

Intranasal                    0.2 – 0.4 mg/kg

Oral                             0.15mg/kg

 

C. If the patient is fully awake and coherent 45 minutes after successfully being given the

     first sedative, the  ordering physician should be contacted and a subsequent

     dose may be given per the above guidelines.

 

D. The patient will be transported to the appropriate diagnostic area by a clinical assistant. 

     An RN and/or MD must accompany the child if the individual child’s level of

     monitoring warrants.  Monitoring (such as continuous pulse oximetry,

     frequent vital signs, or cardiac monitoring) may be ordered by the physician as

     indicated.

 

E. Upon completion of the diagnostic test, the patient will be accompanied by the

    RN/NA/MD back to the inpatient unit.

 

F. The patient will be assessed by the RN upon return to the unit until fully awake and 

    responsive.