LEVELS OF CONSCIOUSNESS AND VENTILATORY PARAMETERS IN YOUNG CHILDREN DURING SEDATION WITH ORAL MIDAZOLAM AND NITROUS OXIDE. † 289

In its guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures, the AAP distinguishes “conscious” from “deep”

sedation to determine needs for personnel and monitoring during painful procedures. The AAP states that the use of N2O in combination with other sedatives automatically constitutes “deep”

sedation yet no data exists to substantiate this statement. We examined levels of consciousness and breathing patterns during sedation with increasing concentrations of N2O following oral

administration of midazolam. Twenty healthy children, 1-3 yrs of age, received oral midazolam, 0.5 mg/kg 15-20 minutes before initiating N2O at concentrations of 15, 30, 45, and 60% in O2

for 4 min at each stage. Ventilation was assessed by pulse oximetry, capnometry, and respiratory impedance plethysmography. At the end of each stage, a sedation score was recorded

(1=uncooperative; 2=verbalizes spontaneously; 3=responds to verbal command or gentle physical stimulation; 4=responds to painful stimulation; 5=no response to painful stimulation).

Differences were assessed by ANOVA; P < 0.05 was considered statistically significant. No child demonstrated significant changes in SpO2, etCO2, or evidence of upper airway obstruction at

any concentration of N2O. At 15% N2O, all children had sedation scores of 3 or less. At 30% N2O, 1 child was deeply sedated, as were 2 children at 45% N2O, and 8 children at 60% N2O

(sedation scores 4 or 5). We conclude that levels of deep sedation may be achieved with the combination of oral midazolam and at least 30% N2O. Supported by the Foundation for Anesthesia

Education and Research with a grant from the Society of Pediatric Anesthesia.

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