Recommendations and standards for analgosedation of pediatric cardiac patients. Position Paper of the German Society for Pediatric Cardiology and Congenital Heart Disease (DGPK)

Background. In pediatric cardiology patients and patients with congenital heart defects, diagnostic procedures and therapeutic interventions are frequently performed. These measures often require adequate sedation and/or analgesia. It is well known that these children tolerate analgosedation better than general anesthesia with intubation. Objective. The German Society for Pediatric Cardiology and Congenital Heart Disease (DGPK) establishes recommendations and defines standards for the periprocedural management of analgosedation in pediatric cardiology patients. These recommendations should serve as a standard for all institutions performing such procedures. Material and methods. Due to a lack of systematic prospective studies the current best practice in Germany was analyzed based on a nationwide survey on this topic. The study analyzed the mode of sedation and analgesia, the relevant diagnostic and therapeutic procedures, the medication used, the monitoring, the personal and structural equipment and the general setting. In addition, the current literature was searched and standards and recommendations were defined based on the results. Results. The individual risk of a diagnostic or interventional procedure under analgosedation is characterized by the intensity of sedation, the type and duration of the procedure, the underlying cardiac problem and the age and current clinical status of the patient. These factors define the extent of periprocedural monitoring. Recommendations for periprocedural management and postprocedural monitoring were elaborated. In patients with a compensated cardiopulmonary situation, for low and moderate risk procedures of short duration and moderate sedation, there is no additional risk profile especially in children more than 1 year old. Analgosedation can be delegated to and safely performed by trained nonmedical personnel under the responsibility of a physician. Dedicated standardized operational protocols (SOP) with quality assurance measures are strongly recommended. Conclusion. Analgosedation is the method of choice for the majority of procedures in pediatric cardiology patients.