How is dosing determined for pediatric sedation?

Updated: May 08, 2018
  • Author: Wan-Tsu Wendy Chang, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Analgesia and sedation should be appropriate for the degree of insult. Although the medication dose is calculated based on weight, the response can vary significantly from one child to the next. Flexibility and careful titration are crucial.

Most analgesics and sedatives in children have a range of acceptable doses, and the emergency department (ED) practitioner may prefer to start with the lowest recommended dose (or even half that) and titrate as needed. Reversal agents, when available, should be kept at the bedside, and their proper doses should be double checked.

Drug absorption, distribution, and elimination can vary with age. Water makes up 70% of body weight in neonates, compared with 55% in adults. Lipid versus water solubility affects the distribution of the agents used. In addition, renal and hepatic elimination improve with age.

An additional method of analgesia can be achieved via intranasal administration of opioids, offering pain relief without the pain associated with intramuscular (IM) administration or intravenous (IV) placement. Saunders et al were able to achieve adequate analgesia with a single intranasal dose of fentanyl in children undergoing orthopedic reduction. [7]

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