title: Analgesia and sedation for painful interventions in children and adolescents.
abstract: BACKGROUND
  Painful procedures on children and adolescents often have to be performed with the aid of analgesia and sedation in order to prevent pain and emotional distress. Moreover, many procedures can be performed more rapidly and more effectively in a relaxed patient. Because the combination of analgesia and sedation can cause serious or even life-threatening complications, it must be accompanied by the same safety precautions as a general anesthetic.
  
  
  METHODS
  Selective review of the literature.
  
  
  RESULTS
  A high level of safety can be achieved by adherence to the published guidelines of the societies for anesthesiology and pediatrics. The depth of sedation during procedures performed under combined analgesia and sedation is often equivalent to that resulting from general anesthesia. Therefore, in order to avoid serious complications, combined analgesia and sedation should only be administered by physicians trained in pediatric anesthesia or pediatric critical care. This is particularly so when propofol is used, because it has a narrow therapeutic range and can cause cardiorespiratory respiratory problems without warning. As long as the appropriate safety precautions are followed, non-anesthesiologists can also administer propofol in combination with an analgesic, such as ketamine, to children and adolescents.
  
  
  CONCLUSIONS
  In children and adolescents, the combination of analgesia and sedation can prevent the emotional trauma that would result from a painful procedure, while often enhancing the quality of the procedure itself. This method should be considered a variant of general anesthesia. Accordingly, any non-anesthesiologist employing this method must be as well versed as an anesthesiologist in the management of its specific side effects and complications.
authors.affiliation: Soins intensifs pédiatriques, Clinique pédiatrique, Centre Hospitalier de Luxembourg, Luxembourg. neuhaeuser.christoph@chl.lu
authors.forename: Christoph
authors.initials: C
authors.lastname: Neuhäuser
authors.forename: Bendicht
authors.initials: B
authors.lastname: Wagner
authors.forename: Matthias
authors.initials: M
authors.lastname: Heckmann
authors.forename: Markus A
authors.initials: MA
authors.lastname: Weigand
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Zimmer
mesh_terms: D000293:Adolescent; D000698:Analgesia / Q000009:adverse effects / Q000379:methods*; D002648:Child; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010146:Pain / Q000517:prevention & control*; D010348:Patient Care Team; D018570:Risk Assessment