CONSCIOUS SEDATION

I. Infant (less than 3 months)

A. Avoid sedation if at all possible
B. Use only reversible agents

II. Pediatric

    A. Sedation only
        1. Nasal midazolam
            a. Dose: 0.2-0.4 mg/kg
            b. Onset: 10-15 min
            c. Duration: 45 min
            d. Reversible
        2. Chloral hydrate
            a. Dose: 50-75 mg/kg PO or PR
            b. Onset: 30-60 min
            c. Duration: 1-8 hr
        3. Propofol
            a. Dose: 1 mg/kg IV bolus then 0.05-0.1 mg/kg/min drip
            b. Onset 30 sec
            c. Duration 8-10 min after stopping drip

    B. Sedation with pain control
        1. Nasal midazolam + local
        2. Ketamine + atropine + midazolam
            a. Premed
                i. Atropine 0.01 mg/kg IV
                ii. Midazolam 0.01 mg/kg IV
            b. Ketamine
                i. Dose: 0.5-1 mg/kg IV
                ii. Onset: 1 min
                iii. Duration: 15 min (30 min for midazolam)

III. Adult

    A. Sedation only
        1. Methohexital
            a. Dose: 0.75-1 mg/kg IV
            b. Onset 45-60 sec
            c. Duration: 5-10 min
        2. Pentobarbital
            a. Dose: 2.5 mg/kg IV
            b. Onset: 45 sec
            c. Duration: 15 min
        3. Propofol
            a. Dose, onset duration as above
            b. Safe in liver and kidney failure; antiemetic and amnestic

    B. Sedation with pain control
          1. Fentanyl + midazolam
              a. Fentanyl
                   i. Dose: 2 micrograms/kg IV
                   ii. Onset 1-2 min
                    iii. Duration 20-30 min
                b. Midazolam as above
                c. Both agents reversible
           2. Ketamine + midazolam
                a. Premed with midazolam as above
                b. Ketamine as above

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