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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
*
[email protected]

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

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