Procedural Sedation

Procedural Sedation: Clinical Practice Guidelines
Procedural Sedation: Clinical Practice Guidelines
Literature Review and History
Procedural sedation is a technique employed in the administration of sedatives or in other
instances dissociative agents with the use of analgesics and in some cases without them. The aim
is to induce a state through which the patient can be able to tolerate unpleasant medical
procedures. Such maintenance is done while the cardiorespiratory function is still intact (Jones &
Heaton, 2017). Children are usually in the emergency department with painful conditions in need
of diagnostics and therapeutic measures that can be regarded as unpleasant to certain extent. The
desired effect is achieved in such settings when procedural sedation is used to manage the pain
felt by the child. The pain is managed together with anxiety. The possible adverse reactions have
to be considered along with the side effects of the medications or a combination of several
medicines. Therefore, the emergency medicine provider has to find comfort in the practice.
Emergency physicians face the challenge of using sedative agents while simultaneously applying
and honing various procedural skills in sedation with safety applications and efficacy for the
pediatric in the emergency department (Jones & Heaton, 2017).
Driving clinical practice along the lines of evidence-based medicine instead of alternative
facts demands that CPGs be composed summary recommendations that capture recent quality
and scientific evidence on a medical issue. CPG is based on a systematic review conducted to
determine presence of a condition (Jones & Heaton, 2017). The process focuses on the strengths
of such evidences by which clinical decision-making is based (Weisz, et al., 2007). The
guidelines have recommendations based on then evidences and value judgments regarding the
benefits and harms of the available options that address the management of a patient. CPG gives
options ranging from diagnosis, examination and intervention. Sedation procedures have become
essential in the performance of procedures on children in pediatric care.
The Institute of medicine defined clinical practice guidelines as systematically developed
guides meant to help doctors and patients arrive at a particular decision in a particular situation.
However, this view has been revised by evidence-based medical care (An, et al., 2016). The
review has led to the definition as statements assessed based on their benefits and harmful
implications, treatment methodologies and the basis of a system through literature including the
optimization methods of care through recommendations (Burbano-Paredes et al., 2017). Within a
period of 30 years, procedural sedation has evolved into a practice that requires peculiar skills
with the growth in indications and settings for practice. The operating room has various
disadvantages because of the logistic and economic disadvantages. The procedures that had been
confined to the operating room but have gone to the emergency department.
Purpose and objective of the CPG
The target population includes infants, children and adolescents still recognized as
patients under pediatric care. The sedation of children is inherently challenging; the challenges
are different from what the adults receive. Procedural sedation is done with the purpose of
ensuring that the performance of a procedure takes place in a safe environment. It recognizes the
ability of a child to recognize his/her own behavior and cooperate with different procedures
based on age and status of development. Children with an age below 6 years and those with
issues of delays in their developmental journey may need to be deeply sedated so that their
behaviors may be controlled compared to children who are older and more cooperative. The
purpose of effective sedation includes: Minimization of discomfort and painful experiences;
control of anxiety while reducing cases of psychological trauma and minimization of amnesia;
control of the way a patient behaves during the procedure while promoting its safe completion;
return the patient’s state to a point where discharge from care is safe.
The Informed Advocate
Parents are charged with the responsibility of becoming advocates of their children by
understanding the legal rights of the family. This is through acquainting themselves with the
provisions of relevant regulations and procedures of what is stated in their rights as legal
custodians of their families. Apart from the legal framework, the parent needs to know
something about the disability of the child so that he or she can better help in addressing it.
Improved Outcomes
One benefit is that outcomes for patients improve. With early interventions, detections can be
made earlier to prevent any further escalation of conditions facing people who have disabilities
(Koegel, Koegel, Ashbaugh, & Bradshaw, 2013). The prospects are bound to change because the
methods of addressing the situation become improved so that the issue can be tackled more
Prevention of Secondary Symptoms
One instance of disability is Autism Spectrum Disorders. There are secondary symptoms that
accompany the primary symptoms. Such symptoms include aggression, tantrums and self-injury
(Koegel, Koegel, Ashbaugh, & Bradshaw, 2013). When the primary symptoms are addressed,
these secondary symptoms are dealt with more effectively and prevented from occurring. Failure
to effectively deal with such symptoms exposes the individual in question to more symptoms
which have the potential of having devastating effects to individuals.
Fiscal Savings
With early interventions, there are fiscal savings are made in the process. This saving is done
when parents are recruited as active interventionists during the process which habilitation is done
(Koegel, Koegel, Ashbaugh, & Bradshaw, 2013). The process is made to occur at an earlier time
to implement an intervention which costs much less.
Contacting Support Groups
Support groups are there to offer the much needed help to people who have special needs.
They offer help socially and emotionally. The parents can help by establishing contact with such
groups on behalf of their children who have certain forms of disabilities.
Getting Additional Help
Additional help comes from various sources such as the larger family, relatives or
friends. These may be of help along with guidance from organizations that deal with children
with disabilities. The help provided by the organizations may help in navigating through various
places to acquire the much needed stamina to help the child through his or her condition.
Participating in a Child’s Services
This means that the parent has to collaborate with the people who aim at providing the
much needed help in raising the child with a disability. Participation may involve either asking
for or providing regular reports on the progress of the child.
In light of these realities, the healthcare systems are making a shift from acute care to
wellness, prevention and accountability. This shift aims at helping stop diseases before they start
and to give people a chance to be healthy and fit. The National Prevention Council Health
Department in the Patient Protection and Affordable Care Act is planning to shift the nation’s
healthcare system from a focus on sickness and diseases to a system focused on prevention and
wellness (Community Catalyst, 2010).This change is driven towards helping patients manage
their health and care by providing them with the information, skills, capabilities and the support
they need to make smarter choices. These changes are in an effort to improve people’s health and
cultivate good health cultures which will result in better and healthy lifestyles. The healthier the
people are the more productive and innovative they will be.
Employees who are free from such issues dealing with mental and physical conditions
that lead to sickness take fewer sick days off; they are more productive and assist in
strengthening the economy. It is for this among many other reasons that many businesses are
making an effort to improve their approach towards their employees’ health by offering them
wellness programs. With the enactment of the Affordable Care Act, wellness programs will
become part of a national public health strategy to help deal with the increase in chronic
diseases. Chronic diseases have become a major concern for employers because of the escalating
healthcare cost. The number of people with chronic conditions has increased with increase in the
age of people. These include conditions such as depression, anxiety and diabetes among others.
Including the wellness program funding in work places will help improve the declining health of
the aging people. A very significant advantage of these programs is that they are cost-beneficial,
saving organizations money in healthcare expenditures and producing a positive return on
Like any other system the healthcare system is facing and will continue to face some
challenges now and then. In past years there have been reports of lack of patient respect by
doctors in different hospitals. Some patients have had very lengthy stays in the hospitals too.
This can be termed as a challenge and in other cases doctors fail to help in prevention of diseases
in cases that would have been easily prevented. In addition, the rising health care costs are a
major challenge in the healthcare system. The issue comes down to reimbursement and revenue.
Medicare and Medicaid reimbursement levels do not cover the cost of care. This forces the
hospital administrations and the doctors to squeeze costs out of the system while trying to keep
good quality and patients’ safety. The system also lacks focus on health and puts more of the
focus on illnesses. Similarly, the system focuses more on a group of clients than on a population.
Recently individuals are being asked to pay more for their own healthcare. This issue will
lead to those with higher incomes being able to afford a wider range of healthcare services while
those with lower incomes will have a challenge getting these services. There are some theories
that the number of uninsured people has been on the rise since the economy softened and the
number of people with employer- sponsored coverage decreased. Research shows that the
uninsured do not receive as good healthcare services as those who are insured. This leads to them
suffering serious health consequences or even financial problems if they get the right care. As a
result local health care systems strain financially when providing care for a large uninsured
population. This will in future cause the system to collapse from the increasing financial pressure
if the number of the uninsured individuals continues to grow.
In as much as new technologies are invented in order to make life easier, they can also
turn out to be a challenge in the system. Many of the newly invented drugs and machines are
expensive and very hard for most of the public to afford. The government and the system are still
trying to find ways in which they can help cover some of these treatments by insurance but this is
yet to be fully put into place. Lack of comprehensive coverage may discourage pharmaceutical
companies from developing products that are clinically beneficial but not rewarding financially.
The actual cost of giving services related to the delivery of health care which includes the cost of
procedures, therapies and medication is what is termed as health care cost for consumers. The
health care cost for consumers has sky rocketed in the past few years (Brill, 2015). This has
caused the consumers to rant and complain over the high prices they now have to pay for the
health care services they receive. Health insurance keeps going up. The amount of money one
has to add for prescription drugs is going up too and all this is because their costs are also going
The healthcare system has significant ways of combating some of the challenges it is
facing. The system is therefore trying to come up with ways to put the patient at the center of
care. This will help improve patient satisfaction and involvement. The shift from acute care to
wellness prevention and accountability is also one of the major ways in which the health care
system is trying to handle these challenges. Emphasis on wellness for the population rather than
cure for diseases, trying to improve the process efficiency and paying close attention to cost
centers are some of the visible efforts that the health care system is trying to use in dealing with
the challenges it faces. Another plan that seems to be taking effect is consolidation; this is where
the most successful hospitals are merging with or absorbing the least successful ones. The
intention is to create a system of integrated and accountable care. This will lead to achievement
of both quality and cost effectiveness.
A Community Program
One viable community program that can be arranged is a public lecture at a renowned
institution and invite the public. the program can be conducted by the state department of public
health in conjunction with the children department and the administration of the organization to
come up with an awareness program where public lectures can be given to make people aware of
the effects and early detection mechanisms they can use to know disability in their children.
Expositions at the seminar can touch on mental and physical disabilities and how to handle them.
The awareness campaign can be used as a forum to educate people on how to handle children
with disabilities. The program can be scheduled for five hours for one week on a biannual
Additional opportunities available
The educational initiatives named above provide their learners with some other
opportunities to better their skills in the health industry. Through the community-based initiative,
the programs can offer the students with a more diverse opportunity of experiencing the real
health sectors and how different duties are carried out. Also, they present the students with
opportunities of being able to develop commitment in their career paths and also to be able to
improve their relationship with different people. Through these opportunities, the students can
establish and enhance new ideas that would positively impact the health industry. The students
are more enlightened about the different communities around them, the health risks that these
communities face and how they would contribute to minimizing these risks. Both educational
programs are working to their best to produce better medical professional for a better health
industry (Institute of Medicine, 2013).
Building a Relationship
One strategy that can work is that of building a relationship between the two centers
involved in a child’s welfare. This can be referred to as building relationships through starting up
family centers that can be able to offer learning materials that learners can borrow from and
make use of in their studies (Best Start Resource Center, 2011). The other activity in the strategy
is making visits to families which have just set up roots in the institution. Activities can also be
held so as to honor the contributions that families make to the institutions in question. One other
way is to set the building as open for use by families in the community and the social services
that have been made available like vaccinations etcetera.
Linking to Learning
The activities that families are connected to have a link established to the learning
process for the child in question. The teachers and parents are involved in the work the student
does and the testing process. The parents and teachers can also initiate special programs such as
extra tuition, tutoring and homework programs where the progress a student makes is monitored
in the process.
Addressing Differences
Differences are addressed through the work done by translators. The teachers and parents
work hand in hand to embrace the diversity occurring in the organization; this is where books
and materials concerning different cultures are encouraged for use to establish that unity. The
Parents and Teachers Association does not bar any family from being a participant.
Sharing Power
The issues involving prejudice and tracking are issues that can be researched upon by
parents. The group of parents focuses on improving the prospects of student achievement where
families get involved where major decisions are being made. Parents can also be involved by
making use of the facilities provided by the school.
Increase in Stress and Other Effects
A disabled child increases stress for the parents of the child in question. It also affects the
mental and physical health of the family because of the stress that comes with having such a
child. It is difficult to obtain proper care for the child (Scully, Barbour, & Roberts-King, 2014).
The decisions made at the place of work are greatly affected by the disability of a child at home.
Decisions that are affected include the decision to have more children, the decisions at the place
of work, and the decisions on education and training for the child. The child also tends to rely on
the support given to him or her by the public. There is reduced esteem in the family and also
guilt and self-blame. Other aspects of attention within the family become diverted. The costs
incurred in medical care on an out-of-pocket basis may be very large. There are also effects on
the quality of life that the two parents involved live. The living arrangement that the parents have
between themselves and the structure of the family also becomes affected.
Organizing a Seminar
Seminar can be scheduled on a regular basis at the childhood organization to facilitate the
process of making people know about disabilities and their effects to the family. A seminar can
help in providing insight to those in attendance so that they can be able to use the information
acquired to deal with the situation of disability in the family. Such a seminar can be organized
for parents who have children in the organization suffering from various disabilities. It can be a
forum where they can invite other parents. The information being shared can be based on the
ways of handling various disabilities in children.
An, S.-Y., Seo, K.-S., Kim, S., Kim, J., Lee, D.-W., Hwang, K.-G., & Kim, H. J. (2016,
December). Developmental procedures for the clinical practice guidelines for conscious
sedation in dentistry for the Korean Academy of Dental Sciences. Journal of Dental
Anesthesia and Pain Medicine, 16(4), 253261. doi:10.17245/jdapm.2016.16.4.253
Brill, S. (2015). America’s Bitter Pill. New York, NY: Random House Publishing Group.
Burbano-Paredes, C. C., Amaya-Guio, J., Rubiano-Pinzón, A. M., Hernández-Caicedo, Á. C., &
Grillo-Ardila, C. F. (2017, JulySeptember). Clinical practice guideline for the
management of sedation outside of operating room in patients over 12 years. Colombian
Journal of Anesthesiology, 45(3), 224-238. doi:org/10.1016/j.rcae.2017.03.006
Community Catalyst. (2010). Summary of the Affordable Care Act. Retrieved June 13, 2017,
from Community Catalyst:
Jones, D. D., & Heaton, H. A. (2017, February 1). Pediatric Procedural Sedation. Retrieved July
19, 2018, from AHC Media:
Weisz, G., Cambrosio, A., Keating, P., Knaapen, L., Schlich, T., & Tournay, V. J. (2007,
December). The Emergence of Clinical Practice Guidelines. The Milbank Quarterly,
85(4), 691727. doi: 10.1111/j.1468-0009.2007.00505.x

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