The Effectiveness of Conscious Sedation in Young Children
Anxiety and fear are universally experienced emotions that create powerful instincts within the human body to protect itself, namely through the stress response or sympathetic nervous system reaction. The term "fight or flight" is commonly used to describe the feeling of dread that can accompany stress reactions (Murray & Zentner, 1997). Every physiologically normal individual has the capability of experiencing the stress reaction. Stress, fear, and anxiety can be pronounced in children who, by medical necessity, frequently undergo tests or procedures to diagnose or to treat a medical problem. Considering that children, by the nature of well visits and childhood illnesses, come in frequent contact with health care providers and services, special consideration must be undertaken to reduce their anxiety during stressful medical encounters and procedures. In addition, attention to developmental considerations is important, especially in toddler and preschool children in whom magical thinking predominates, accompanied by fears of body mutilation and loss of integrity.

Anxiety and pain are often overlooked during minor, common procedures in pediatrics. Young children often are not able to control their anxiety levels in a way that allows health care professionals to treat their conditions without physically restraining them to ensure safety. However, restraint does not typically provide a reduction in anxiety and may intensify fears as well as feelings of helplessness. Because of the negative consequences that may accompany physically restraining children, a trend is underway to reduce anxiety and decrease complications in children experiencing painful or stressful procedures with the use of conscious sedation. The American Academy of Pediatrics (AAP) defines conscious sedation as "a medically controlled state of depressed consciousness that: (a) allows protective reflexes to be maintained; (b) retains the patient's ability to maintain a patent airway independently and continuously; and (c) permits appropriate response by the patient to physical stimulation or verbal command" (AAP, 1992, p. 1110). In order to determine the effectiveness of conscious sedation in pediatrics, a search was undertaken to answer the following PICO (i.e., population, intervention of interest, comparison group, outcome) (Melnyk & Fineout-Overholt, 2002) question, "In children undergoing painful medical procedures, what is the effect of conscious sedation versus no sedation or a placebo in reducing anxiety and pain as well as procedural complications?"