(ACEP) organized a multidisciplinary effort to create a clinical practice guideline specific to unscheduled, time-sensitive procedural sedation, which differs in important ways from scheduled, elective procedural sedation. The purpose of this guideline is to serve as a resource for practitioners who perform unscheduled procedural sedation regardless of location or patient age. This document outlines the underlying background and rationale, and issues relating to staffing, practice, and quality improvement. [

Objective-Most studies of ketamine administered to children for procedural sedation are limited to emergency department use. The objective of this study was to describe the practice of ketamine procedural sedation outside of the operating room and identify risk factors for adverse events.Design-Observational cohort review of data prospectively collected from 2007 to 2015 from the multicenter Pediatric Sedation Research Consortium.Setting-Sedation services from academic, community, free-standing children's hospitals and pediatric wards within general hospitals.Patients-Children from birth to 21 years old or younger. Interventions-None.Measurements and Main Results-Describe patient characteristics, procedure type, and location of administration of ketamine procedural sedation. Analyze sedation-related adverse Drs, Grunwell and Kamat conceived and developed the study and wrote the article. Drs. Travers and McCracken conducted statistical analyses and edited the article. Drs. Scherrer, Stormorken, Chumpitazi, Roback, and Stockwell edited the article. All authors read and approved the article.Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/pccmjournal).The remaining authors have disclosed that they do not have any potential conflicts of interest. Conclusions-This is a description of a large prospectively collected dataset of pediatric ketamine administration predominantly outside of the operating room. The overall incidence of severe adverse events was low. Risk factors associated with increased odds of adverse events were as follows: cardiac and gastrointestinal disease, lower respiratory tract infection, and the coadministration of propofol and anticholinergics. HHS Public AccessKeywords adverse events; ketamine; laryngospasm; pediatric procedure sedation; risk factorsThere is a growing demand to provide procedural sedation (PS) for children outside of the operating room (OR). Subspecialists such as intensivists, emergency medicine physicians, anesthesiologists, and hospitalists, all provide PS for children. Ketamine has been used by emergency medicine physicians for well over 2 decades for primarily painful procedures (1-13). We used the Pediatric Sedation Research Consortium (PSRC) database to describe the administration of ketamine during PS, characterize the adverse events (AEs), and identify the risk factors associated with AEs or severe AEs (SAEs). Based on previous studies, we hypothesized that age less than 12 months or greater than 13 years, coadministration of anticholinergics or benzodiazepines, lower respiratory tract illness, and American Society of Anesthesiologists-Physical Status (ASA-PS) greater than or equal to III would be associated with an AEs (12,(14)(15)(16)(17). METHODS Study Design and Data CollectionThis study is an observational cohort review of prospectively collected data obtained from the multicenter PSRC dat...

• Intravenous magnesium did not shorten length of stay for pain crisis in children with sickle cell anemia.• Collaboration between pediatric emergency medicine and hematology allowed for successful enrollment in a sickle cell acute management trial.Magnesium, a vasodilator, anti-inflammatory, and pain reliever, could alter the pathophysiology of sickle cell pain crises. We hypothesized that intravenous magnesium would shorten length of stay, decrease opioid use, and improve health-related quality of life (HRQL) for pediatric patients hospitalized with sickle cell pain crises. The Magnesium for Children in Crisis (MAGiC) study was a randomized, double-blind, placebo-controlled trial of intravenous magnesium vs normal saline placebo conducted at 8 sites within the Pediatric Emergency Care Applied Research Network (PECARN). Children 4 to 21 years old with hemoglobin SS or Sb 0 thalassemia requiring hospitalization for pain were eligible. Children received 40 mg/kg of magnesium or placebo every 8 hours for up to 6 doses plus standard therapy. The primary outcome was length of stay in hours from the time of first study drug infusion, compared using a Van Elteren test. Secondary outcomes included opioid use and HRQL. Of 208 children enrolled, 204 received the study drug (101 magnesium, 103 placebo). Between-group demographics and prerandomization treatment were similar. The median interquartile range (IQR) length of stay was 56.0 (27.0-109.0) hours for magnesium vs 47.0 (24.0-99.0) hours for placebo (P 5 .24). Magnesium patients received 1.46 mg/kg morphine equivalents vs 1.28 mg/kg for placebo (P 5 .12). Changes in HRQL before discharge and 1 week after discharge were similar (P > .05 for all comparisons). The addition of intravenous magnesium did not shorten length of stay, reduce opioid use, or improve quality of life in children hospitalized for sickle cell pain crisis. This trial was registered at www.

Objectives: Outcomes associated with a sedative regimen com prised ketamine + propofol for pediatric procedural sedation outside of both the pediatric emergency department and operating room are underreported. We used the Pediatric Sedation Research Consortium database to describe a multicenter experience with ketamine + propofol by pediatric sedation providers. Design: Prospective observational study of children receiving IV ketamine + propofol for procedural sedation outside of the operating room and emergency department using data abstracted from the Pediatric Sedation Research Consortium during 2007–2015. Setting: Procedural sedation services from academic, community, free-standing children’s hospitals, and pediatric wards within general hospitals. Patients: Children from birth to less than or equal to 21 years old. Interventions: None. Measurements and Main Results: A total of 7,313 pediatric procedural sedations were performed using IV ketamine + propofol as the primary sedative regimen. Median age was 84 months (range, < 1 mo to < 21 yr; interquartile range, 36–144); 80.6% were American Society of Anesthesiologists-Physical Status less than III. The majority of sedation was performed in dedicated sedation or radiology units (76.1%). Procedures were successfully completed in 99.8% of patients. Anti­cholinergics (glycopyrrolate and atropine) or benzodiazepines (midazolam and lorazepam) were used in 14.2% and 41.3%, respectively. The overall adverse event and serious adverse event rates were 9.79% (95% Cl, 9.12–10.49%) and 3.47% (95% Cl, 3.07–3.92%), respectively. No deaths occurred. Risk factors associated with an increase in odds of adverse event included ASA status greater than or equal to III, dental suite, cardiac catheterization laboratory or radiology/sedation suite location, a primary diagnosis of having a gastrointestinal illness, and the coadministration of an anticholinergic. Conclusions: Using Pediatric Sedation Research Consortium data, we describe the diverse use of IV ketamine + propofol for procedural sedation in the largest reported cohort of children to date. Data from this study may be used to design sufficiently powered prospective randomized, double-blind studies comparing outcomes of sedation between commonly administered sedative and analgesic medication regimens.