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Safety of pediatric procedural sedation in a Canadian emergency department

Published online by Cambridge University Press:  21 May 2015

Urbain Ip  and
Anurag Saincher
Urbain Ip*
Affiliation:
Department of Emergency Medicine, Surrey Memorial Hospital, Surrey, BC
Anurag Saincher
Affiliation:
Department of Emergency Medicine, Surrey Memorial Hospital, Surrey, BC
*
Urbain.Ip@sfvhr.hnet.bc.ca

Abstract

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Objective:

To assess the safety of pediatric procedural sedation performed by emergency physicians working within a structured sedation protocol.

Methods:

A retrospective review of all children undergoing emergency department (ED) procedural sedation during a 2-year period after the institution of a structured sedation protocol.

Results:

167 children underwent procedural sedation, primarily for orthopedic manipulation, wound management and foreign body removal. Of these, 82% received ketamine, 17% received fentanyl and midazolam and 1% received midazolam alone. Sedation was adequate in all but 6 patients, who required supplemental ketamine for orthopedic manipulation. Vomiting after arousal occurred in 17 children (10%), but no episodes of clinical aspiration occurred. One child became agitated during recovery and another experienced a transient visual hallucination. There were no cases of laryngospasm, apnea or cardiorespiratory compromise, and no mortality or significant morbidity occurred.

Conclusion:

Emergency physicians using a structured sedation protocol can safely perform ED pediatric procedural sedation. Where intravenous access is not already present, intramuscular ketamine, administered in the doses described, is a safe and effective agent for pediatric sedation.

Keywords

procedural sedationconscious sedationpediatricketamineemergency department
Type
Pediatrics • Pédiatrie
Information
Canadian Journal of Emergency Medicine , Volume 2 , Issue 1 , January 2000 , pp. 15 - 20
Copyright
Copyright © Canadian Association of Emergency Physicians 2000

References

1.Chuang, E, Wenner, WJ Jr, Piccoli, DA, Altschuler, SM, Liacouras, CA.Intravenous sedation in pediatric upper gastrointestinal endoscopy. Gastrointest Endosc 1995;42:156–60.CrossRefGoogle ScholarPubMed
2.Lu, DP, Lu, GP, Reed, JF III. Safety, efficacy, and acceptance of intramuscular sedation: assessment of 900 dental cases. Compendium 1994;15:1348.Google ScholarPubMed
3.Shane, SA, Fuchs, SM, Khine, H.Efficacy of rectal midazolam for the sedation of preschool children undergoing laceration repair. Ann Emerg Med 1994;24:1065–73.CrossRefGoogle ScholarPubMed
4.Pohlgeers, AP, Friedland, LR, Keegan-Jones, L.Combination fentanyl and diazepam for pediatric conscious sedation. Acad Emerg Med 1995;2:879–83.CrossRefGoogle ScholarPubMed
5.Alfonzo-Echeverri, EC, Berg, JH, Wild, TW, Glass, NL.Oral ketamine for pediatric outpatient dental surgery sedation. Pediatr Dent 1993;15:182–5.Google ScholarPubMed
6.Qureshi, FA, Mellis, PT, McFadden, MA: Efficacy of oral ketamine for providing sedation and analgesia to children requiring laceration repair. Pediatr Emerg Care 1995;11:93–7.CrossRefGoogle ScholarPubMed
7.Varela, CD, Lorfing, KC, Schmidt, TL.Intravenous sedation for the closed reduction of fractures in children. J Bone Joint Surg Am 1995;77:340–5.CrossRefGoogle ScholarPubMed
8.Schechter, NL, Weisman, SJ, Rosenblum, M, Bernstein, B, Conard, PL.The use of oral transmucosal fentanyl citrate for painful procedures in children. Pediatrics 1995;95:335–9.Google ScholarPubMed
9.Pruitt, JW, Goldwasser, MS, Sabol, SR, Prstojevich, SJ.Intramuscular ketamine, midazolam, and glycopyrrolate for pediatric sedation in the emergency department. J Oral Maxillofac Surg 1995;53:13–7.CrossRefGoogle ScholarPubMed
10.Louon, A, Reddy, VG.Nasal midazolam and ketamine for pediatric sedation during computerized tomography. Acta Anaesthiol Scand 1994;38:259–61.CrossRefGoogle Scholar
11.Parker, RI, Mahan, RA, Giugliano, D, Parker, MM.Efficacy and safety of intravenous midazolam and ketamine as sedation for therapeutic and diagnostic procedures in children. Pediatrics 1997; 99:427–31.CrossRefGoogle ScholarPubMed
12.Dachs, RJ, Innes, GM.Intravenous ketamine sedation of pediatric patients in the emergency department. Ann Emerg Med 1997; 29:146–50.CrossRefGoogle ScholarPubMed
13.Roelofse, JA, Joubert, JJ, Roelofse, PG.A double-blind randomized comparison of midazolam alone and midazolam combined with ketamine for sedation of pediatric dental patients. J Oral Maxillofac Surg 1996;54:838–44.CrossRefGoogle ScholarPubMed
14.Petrack, EM, Marx, CM, Wright, MS.Intramuscular ketamine is superior to meperidine, promethazine, and chlorpromazine for pediatric emergency department sedation. Arch Pediatr Adolesc Med 1996;150:676–81.CrossRefGoogle ScholarPubMed
15.Graff, KJ, Kennedy, RM, Jaffe, DM.Conscious sedation for pediatric orthopaedic emergencies. Pediatr Emerg Care 1996;12:31–5.CrossRefGoogle ScholarPubMed
16.Riavis, M, Laux-End, R, Carvajal-Busslinger, MI, Tschappeler, H, Bianchetti, MG.Sedation with intravenous benzodiazepine and ketamine for renal biopsies. Pediatr Nephrol 1998;12:147–8.Google Scholar
17.Green, SM, Rothrock, SG, Lynch, EL, Ho, M, Harris, T, Hestdalen, R, et al. Intramuscular ketamine for pediatric conscious sedation in the emergency department: safety profile in 1,022 cases. Ann Emerg Med 1998;31:688–97.CrossRefGoogle Scholar
18.Egelhoff, JC, Ball, WS Jr, Koch, BL, Parks, TD.Safety and efficacy of sedation in children using a structured sedation program. AJR Am J Roentgenol 1997;168:1259–62.CrossRefGoogle ScholarPubMed
19.Litman, RS.Apnea and oxyhemoglobin desaturation after intramuscular ketamine administration in a 2-year-old child. Am J Emerg Med 1997;15:547–8.Google Scholar
20.Green, SM, Rothrock, SG.Intravenous ketamine for pediatric sedation in the emergency department, safety profile with 156 cases. Acad Emerg Med 1998;5:971–6.CrossRefGoogle ScholarPubMed
21.Epstein, FB.Ketamine dissociative sedation in pediatric emergency medical practice. Am J Emerg Med 1993;11:180–2.Google Scholar
22.Gremse, DA, Kumar, S, Sacks, AI.Conscious sedation with highdose midazolam for pediatric gastrointestinal endoscopy. South Med J 1997;90:821–5CrossRefGoogle ScholarPubMed
23.Soliman, MG, Brinale, GF, Kuster, G.Response to hypercapnia under ketamine anaesthesia. Can Anesth Soc J 1975;22:486–94.Google Scholar
24.Smith, JA, Santer, LJ.Respiratory arrest following intrmuscular ketamine injection in a 4 year old child. Ann Emerg Med 1993;22:613–5.Google Scholar