March 2025
Clinicians must be vigilant when sedating any child who has respiratory distress including acute asthma.
If sedation is required for a procedure, e.g. intravenous cannulation, suturing, etc, the risk of sedation versus no sedation should be weighed up. Consider if the procedure could be achieved with just local/topical anaesthetic.
The use of nitrous oxide for sedation is contraindicated in children with severe asthma. In patients with asthma, nitrous oxide can decrease forced vital capacity, exacerbate secretions, and reduce respiratory drive (both in response to hypoxaemia and hypercarbia).
Be aware that the application of a sealed mask to the face of a child to deliver nitrous oxide can be distressing to the child, particularly young children. This distress may result in dis-coordinate breathing or breath holding. This is often transient, but for children with respiratory distress, it may worsen oxygenation, compromise ventilation, and increase stress, all of which can make asthma worse.
When administering any form of sedation, a child must be monitored continuously. This includes pulse oximetry (SaO2), heart rate and direct observation of respiratory rate and respiratory effort. Any sedation given to children with respiratory distress, including asthma, should be supervised by a senior doctor skilled in managing unstable patients, and there should be a pre-planned contingency if any deterioration occurs.