Protocols - Hemorio

ATTACHMENT VIII – SEDATION IN CHILDREN
LOCAL – Invasive procedures room (ground floor, 6 th , 7 th or 8 th )
RESOURCES
AVAILABLE
KETAMINA
PROTOCOL
KETAMINA EFFECTS
CONTRAINDICATIONS
ANTAGONIST OF
BENZODIAZEPINE
(FLUMAZENIL)
MIDAZOLAN
– O2 output with continuous flow;
– Ambu (child and adult) with a O2 reservoir and mask (child, adult and
teenager);
– Tubes of different gauges, Guedel cannule;
– Drugs: adrenaline, atropine, muscle relaxing, lasix, lidocaine, gliconate,
benzodiazepine antagonist (Flumazenil).
Initial dose
Dilution
cares
Clinical
cares
– Intravenous – 0.025 – 1 mg/Kg (start 1 – 2 min)
– Intramuscular – 5 – 6 mg/Kg (start 5 – 10 min)
– You may repeat 5 minutes thereafter, if the sedation is
improper, until the total dose of 2mg/Kg
– Flask ampule 1ml = 50mg
– Dilution in distilled water or SF
– Fasting of 4-6h, before all procedures, no matter the
administration path of the sedative;
– All sedatives require vigilance and monitoring during and after
the procedure (ASA, AAP, SBA and CFM);
– Half-life of 2h, but the child starts waking up in 30 min, after
the last dose. He can go home, provided that he is able to
walk (usually in 90 min).
– Only dose IM is used for combative children who refuse to
perform the procedure.
– Horizontal nistagmus or staring (sedation sign)
– Dissociate sedation;
– Induces a fast unconsciousness, with a spontaneous breathing
– Increase of PA, FC and PIC
– Sialorrhea, being indicated a dose of Atropine of 0.01mg/Kg, because the
secretion may cause a laryngeal stimulation and cough;
– In older children, it may present delirium, which may be prevented with the
usage of small, not repeated doses of Benzodiazepine (midazolam 0.03 to
0.1 mg/Kg)
– It must not be used in force of HIC, aneurism, thyreotoxycosis, CHF, angina
and psychiatric states
– The antagonist has a half-life smaller than benzodiazepine, and a resedation
may occur. If the dose has been given in excess, keep the child
under observation;
– The Dose 0.1mg/Kg (you may repeat every 1 minute, if there is no
response, up to the total of the cumulative dose of 1-3mg in 1h).
Initial Dose - 0.1 to 0.3/kg
- Maximum dose – 10 mg in bolus 5 – 10 minutes in AD
- If necessary, repeat in 15 to 20 minutes 50% of the initial dose.
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