providers Parents are often the best source of information about the child’s expected reaction to the procedure Some parents may know that, despite a pain-free procedural technique using topical anesthetic for a facial laceration, their child will be so fearful of strangers that nonpharmacologic techniques will not suffice Conversely, a parent may express that her child was calm throughout his or her last laceration repair and may only need distraction during the procedure in addition to local analgesia TABLE 129.4 INFORMATION THAT CAN ASSIST CLINICIAN IN DETERMINING TYPE OF AGENT NEEDED FOR PROCEDURAL SEDATION AND ANALGESIA Procedure Patient Agent Expected pain severity Expected pain duration Required duration of immobility Expected distress or fear caused by procedure Current pain rating Prior experiences Developmental age Onset Duration Desired effects Initial reaction to provider Parental expectation Unwanted effects METHODS OF DELIVERY Delivery route of analgesics and sedatives is an important consideration when choosing an analgesic or PSA regimen Pharmacologic factors such as drug onset, absorption, and duration of action can affect choice of delivery The safety of certain medications and regimens should be taken into account; the presence of a working peripheral IV line allows for quick delivery of reversal agents or resuscitation medications Conversely, while an IV delivery route may be preferred in a certain instance, IV placement may not be possible due to body habitus, vein sclerosis, dehydration, or patient cooperation, among others, and a different delivery route must be considered The IM route is not ideal because it causes delayed drug absorption and the dosage of drug given cannot be titrated Subcutaneous