Use of sedation and local anesthesia to prepare children for procedures.

Analgesic and sedative needs depend on the type of procedure, the child's age and the degree of cooperation from the child and parents. Local anesthesia, which may be administered subcutaneously or in topical gel form, generally is sufficient for common procedures such as lumbar puncture and laceration repair. Frequently used local anesthetics in children include buffered lidocaine, the eutectic mixture of lidocaine and prilocaine and the combination of tetracaine, adrenaline and cocaine. To reduce the potential for systemic absorption and toxicity, anesthetics should not be applied on or near mucosal areas. To minimize drug interactions, only a single sedating drug should be used, with dosage limits defined and never exceeded. If sedation is necessary, continuous pulse oximetry, a resuscitation cart and personnel trained in sedative drug use and advanced airway management must be available. Because of its therapeutic index and low toxicity, chloral hydrate has long been a popular sedative-hypnotic drug. Midazolam may be considered when amnesia is desired.