Practice Guidelines

Sedation for diagnostic and therapeutic procedures in children and young people: summary of NICE guidance

BMJ 2010; 341 doi: (Published 16 December 2010) Cite this as: BMJ 2010;341:c6819
  1. Mike Sury, consultant anaesthetist 1, honorary senior lecturer2,
  2. Ian Bullock, chief operating officer3,
  3. Silvia Rabar, project manager3,
  4. Kathleen DeMott, research fellow3
  1. 1Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK
  2. 2PORTEX Unit of Paediatric Anaesthesia, Institute of Child Health, University College London, WC1N 1EH
  3. 3National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE
  1. Correspondence to: M Sury surym{at}

Children often need effective sedation or anaesthesia for minor procedures. Although a wide range of sedation techniques is available, sedation may not always be effective, causing distress and additional cost (related to repeat procedures); some techniques may occasionally cause unintended loss of consciousness with sudden and potentially dangerous airway obstruction and respiratory depression.

These problems can be minimised by choosing effective and appropriate techniques and ensuring that healthcare practitioners are trained and able to prevent harm. However, guidance on which technique is effective for specific procedures, and the training and resources needed to deliver them safely, has been absent. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on effective and safe sedation of children and young people undergoing common diagnostic and therapeutic procedures.1


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Assessment, communication, patient information, and consent

  • Establish suitability for sedation by assessing current medical condition and any surgical problems; weight (growth assessment); past medical problems (including any associated with sedation or anaesthesia); current and previous medication (including any allergies); physical status (including the airway); and psychological and developmental status. [Based on the experience and opinion of the Guideline Development Group (GDG)]

  • Seek further advice from a specialist before giving sedation if you are concerned about a potential airway or breathing problem in a child or young person assessed as grade 3 or greater on the American Society of Anesthesiologists (ASA) scoring tool and for all neonates and infants. [Based on the experience and opinion of the GDG] The ASA …

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