Sedação para procedimentos em crianças e adolescentes: uma proposta a partir do sistema GRADE

Abstract

Performing painful or unpleasant diagnostic and therapeutic interventions has a greater chance of success and is safer when pain and anxiety are effectively controlled. This article aims to elaborate recommendations on procedural sedation in children and adolescents, by non-anesthesiologists, using the best evidence available. A literature search was carried out, which included the main summaries and guidelines on the subject and the GRADE system was used to rank the set of evidence that supports each recommendation. The sedation for procedures consists of 5 steps: preparation, monitoring, non-pharmacological interventions, pharmacological interventions and discharge. The preparation involves clinical evaluation, preparation of the team and material. Patient monitoring should be rigorous, according to the level of sedation. Capnography did not reduce the rate of significant adverse events, and its use is recommended when available, but not mandatory. Among the non-pharmacological interventions, there is evidence of moderate quality to support the use of distraction and hypnosis techniques. Evidence is insufficient to recommend the use of one drug in superiority to another, and the choice should be made according to the type of procedure, baseline clinical status / comorbidity of each patient and predicting adverse events associated with each drug. To ensure safe discharge, the patient must meet specific criteria, returning to their initial functional condition.