I recently learned of a departmental policy at my institution where pediatric patients are not allowed to receive more than 45 minutes of IV sedation for procedures in the emergency department (entirely under the independent and direct supervision of a physician licensed to provide sedation to children), and if we anticipate a procedure taking longer than this then we are required to set the patient up for the operating room with general anesthesia. This time limit includes any time spent performing an exam while under sedation, in addition to the actual procedure needing to be done. The procedures my specialty performs are often not complex, just time intensive, and the patients are always hemodynamically stable without any life threatening injuries prior to our service attempting any procedure.
The cited reason for the policy is that it is unsafe for children to receive IV sedation for more than 45 minutes.
I have always thought subjecting a child to general anesthesia and intubation presents a much larger risk to children, not to mention the tremendous costs associated with taking a patient to the operating room.
I have looked into the literature and have not found a single source to back up this claim. I'm wondering if any of my colleagues on meddit have any sources discussing the safe duration of IV sedation in pediatric patients?
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