TABLE 2

Comparison of Moderate and Deep Sedation Equipment and Personnel Requirements

Moderate SedationDeep Sedation
PersonnelAn observer who will monitor the patient but who may also assist with interruptible tasks; should be trained in PALSAn independent observer whose only responsibility is to continuously monitor the patient; trained in PALS
Responsible practitionerSkilled to rescue a child with apnea, laryngospasm, and/or airway obstruction including the ability to open the airway, suction secretions, provide CPAP, and perform successful bag-valve-mask ventilation; recommended that at least 1 practitioner should be skilled in obtaining vascular access in children; trained in PALSSkilled to rescue a child with apnea, laryngospasm, and/or airway obstruction, including the ability to open the airway, suction secretions, provide CPAP, perform successful bag-valve-mask ventilation, tracheal intubation, and cardiopulmonary resuscitation; training in PALS is required; at least 1 practitioner skilled in obtaining vascular access in children immediately available
MonitoringPulse oximetryPulse oximetry
ECG recommendedECG required
Heart rateHeart rate
Blood pressureBlood pressure
RespirationRespiration
Capnography recommendedCapnography required
Other equipmentSuction equipment, adequate oxygen source/supplySuction equipment, adequate oxygen source/supply, defibrillator required
DocumentationName, route, site, time of administration, and dosage of all drugs administeredName, route, site, time of administration, and dosage of all drugs administered; continuous oxygen saturation, heart rate, and ventilation (capnography required); parameters recorded at least every 5 minutes
Continuous oxygen saturation, heart rate, and ventilation (capnography recommended); parameters recorded every 10 minutes
Emergency checklistsRecommendedRecommended
Rescue cart properly stocked with rescue drugs and age- and size-appropriate equipment (see Appendices 3 and 4)RequiredRequired
Dedicated recovery area with rescue cart properly stocked with rescue drugs and age- and size-appropriate equipment (see Appendices 3 and 4) and dedicated recovery personnel; adequate oxygen supplyRecommended; initial recording of vital signs may be needed at least every 10 minutes until the child begins to awaken, then recording intervals may be increasedRecommended; initial recording of vital signs may be needed for at least 5-minute intervals until the child begins to awaken, then recording intervals may be increased to 10–15 minutes
Discharge criteriaSee Appendix 1See Appendix 1