SEDATION IN CHILDREN

NITROUS OXIDE (N2O) AS CONSCIOUS SEDATION

• Route - Inhalation 
• Dose - 40% N2O +60%  O2 

• It causes DIFFUSION HYPOXIA when sedation is reversed at the end of procedure. This can be prevented by maintaining 100% oxygen for 5-10 min. after sedation procedure.                                                                                                                                
•  5-25% N2O : Modern Sedation, Diminution of fear and anxiety, Marked Relaxation.      
•  25-45% N2O : Dissociation Sedation and analgesia, Floating Sensation, Reducing blink rate, Euphoric state (laughing gas). 
•  45-65% N2O: Total Anaesthesia, Analgesia, Amnesia (AAA)   

• ContraIndication of N2O: COPD, Asthma, Resiratory infections, Sickle Cell Anemia, Otitis Media, Epilepsy.

         SIDE EFFECTS OF OTHER SEDATIVES IN CHILDREN

1. Barbituarates
   -PARADOXICAL  HYPER EXCITABILITY than sedation in some children.
                           
2. Ketamine 
   -Route- IM, DISSOCIATIVE  type of anesthesia.
3. Promethazine
   -Route- Oral , used with caution in child with SLEEP APNEA or family history of SUDDEN INFANT DEATH SYNDROME (SIDS)
4. Chlorpromazine                                                                 
   - Used in combination with Mepridine and promethazine  (LYTIC COCKTAIL)
5. Diazepam                                                                                    -THROMBOPHLEBITIS , ATAXIA                                                           
6. Midazolam                                                                                  -Dose:Oral: 0.25-1 mg/kg, Max. 20mg; IM: 0.1-0.15 mg/kg, Max. 10mg; Syrup: 2mg/ml; Injectable: 1mg/ml & 5mg/ml vials
   -RESPIRATORY DEPRESSION