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Analgesia and sedation for procedures

Some procedures have to be undertaken immediately, to save life, and many such procedures are described in this section. Clearly, there is no time to use analgesia in these circumstances, nor indeed much need to do so, as children who are in such severe collapse will have significantly depressed conscious levels. Where there is consciousness, analgesia and/or sedation is a top priority.

(For details on pain assessment and analgesia, see Section 1.15.)

For some procedures (e.g. chest tube insertion, dressing of burns), analgesia with a powerful drug such as ketamine should be considered, with a skilled healthcare worker (usually an anaesthetist) present and able to treat any adverse reactions immediately (see Section 1.24).

For planned intubation, anaesthesia is induced first (see Section 1.24). For some rarely used procedures such as defibrillation for cardiac arrest caused by a shockable rhythm (see Section 1.13), there is neither time nor need for sedation, as the patient is unconscious, whereas for defibrillation for an arrhythmia, sedation is necessary in most cases (see Section 5.4.C).

If ketamine is being used, give 2–4 mg/kg IM. This takes 5–10 minutes to act and the effects last for about 20 minutes. Ketamine can also be given slowly IV in this situation, 250–500 microgram/kg IV, and repeated as required to control pain. An anaesthetist or other expert in airway control must be present when ketamine is used. When giving any analgesia, manage the child’s airway, beware of respiratory depression and monitor oxygen saturation with a pulse oximeter (if available). Ensure that you have a resuscitation bag and mask available (and oxygen).



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