ORTHOPAEDIC DEPARTMENT

HOSPITAL TELUK INTAN,

36000 TELUK INTAN, PERAK.
TEL 05-6298400
SAMB.8629,8630,86310,8631,8632,8633
KEMENTERIAN KESIHATAN Fax: 05-6212415
MALAYSIA

Protocol for Paediatric Patients Requiring Sedation

Precautions :
 Sedation for infants less than 1 year, patients with airway or breathing problems, psychological/
developmental problems or comorbidities ASA grade 3 or higher must be discussed/planned with a
Paediatrician
 Chloral hydrate is contraindicated in severe renal, liver and cardiac impairment.

Date : Time : Ward :

Name : Age :

IC : Weight(kg)
:

Diagnosis : Signature
& stamp of
doctor
Procedure :

1. Preparing For Sedation

Consent for sedation includes: Yes  No 
 Proposed sedation technique
 Alternatives to sedation (not all patients will require procedural sedation)
 Associated risks and benefits

Checklist before administering sedation

1. Vital signs :
BP : SPO2 :
HR : RR :
Temperature :

Bil YES NO
2. Time since last meal (clear fluid/milk/solid) : hours
3. IV access
4. Allergy/drug reaction (specify )
5. History of sedation/anaesthesia/asthma
6. Any complication during previous sedation
7. Physical examination (including evaluation of airway)
8. Presence of psychological/developmental problems
9. Two trained and credentialed personnel present
10 Monitoring and resuscitation equipment available
.
11 Reversal available
.
12 Medication labelling (Medication name, route and dosage)
.

2. Choosing Sedation Technique

* Preparation and introduction of sedation, to be performed by the same person with supervision of senior
officer

Recommended dosage
 IV Midazolam 0.1-0.2mg/kg (adult 5mg) up to 0.5mg/kg used in children
(1ampoule : 5mg in 1ml) (To dilute by adding 4ml of NS) (Final concentration : 1mg/ml)
[Antidote : IV Flumazenil 5mcg/kg every 60sec until awake (max total 50mcg/kg ; adult 2mg); then
2-10mcg/kg/hr if overdose]
 IV Fentanyl 1-2mcg/kg (adult 50-100mcg)
(1ampoule : 100mcg in 2ml) (To dilute by adding 8ml of NS)
(Final concentration : 10mcg/ml)
[Antidote : IV Naloxone 0.002mg/kg (0.4mg diluted to 20ml, give 0.1ml/kg/dose) repeat every 2min
x 4 if required, then 0.3mg/kg in 30ml at 1ml/hr(0.01mg/kg/hr) IV]

3. Monitoring During/After Procedure

Sedation given :
Drug Dosage Time given Route Signature

Observation (NOTE : abandon procedure and resuscitate if SPO2 < 92%)

Time Heart Rate SPO2 RR Signature
0 min
15min
30min
45 min
60 min
90 min
120 min
Monitor every 15 minutes until patient is awake, then every 30 minutes until discharge
(To observe at least 2 hours post sedation)

4. Sedation Failure
 Abandon procedure if no or inadequate response to sedation
 Arrange new date for procedure as inpatient, KIV Anaesthetic referral.

5. Discharge Criteria (ALL criteria MUST be met)

 Stable vital sign
BP: SPO2:
HR: RR:

 Able to swallow fluid, presence of cough/gag reflex Yes  No 

 Alert, able to sit unaided Yes  No 
 Abscence of nausea, vomiting, respiratory depression Yes  No 
 Follow-up appointment given Yes  No 

Time of discharge:
Signature & stamp of discharging doctor :