Sedation scales and discharge criteria: How do they differ? which one to choose? do they really apply to sedation?

Abstract

Assessing the depth of sedation in children is critically important to determine whether the goals of sedation are met without exposing the patient to the risk of adverse outcomes. In Cravero’s model of pediatric sedation, the patient’s state ranges from fully awake undergoing a painful procedure without sedation or analgesia to apnea, hypoxia, and death from oversedation. Clearly, having the sedated child’s state in the goal zone is important, and objective tools to assess sedation depth are necessary to standardize depth of sedation. Additionally, having objective assessment scales available to rate a child’s readiness for discharge from a sedation recovery area is also important, as premature discharge may lead to adverse events and even death. This chapter will review commonly used pediatric sedation scales, focusing on procedural sedation. Then methods of sedation assessment using processed EEG will be reviewed and compared to pediatric sedation scales.