Combined nitrous oxide 70% with intranasal fentanyl for procedural analgosedation in children: a prospective, randomised, double-blind, placebo-controlled trial

Staubli, Georg; Landolt, Markus A.

doi:10.1136/emermed-2018-207892

Cited by 10 publications

(3 citation statements)

References 23 publications

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“…6 The risk of emesis for co-administered intranasal fentanyl with N 2 O was reported to be 10-27.5%, with increased rates at 70% N 2 O. 3,7 In our study, the emesis rate was 1.4% with N 2 O alone, and 3.7% (2/54) for intranasal fentanyl with N 2 O. This is also lower than the emesis rates (8.4%) with IM ketamine sedation reported.…”

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confidence: 53%

Safety and effectiveness of nitrous oxide procedural sedation in a paediatric emergency department

Tan

Tham

2023

Ann Acad Med Singap

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Safety and effectiveness of nitrous oxide procedural sedation in a paediatric emergency departmentLETTER TO THE EDITOR Dear Editor, Nitrous oxide (N 2 O) produces dissociative euphoria, amnesia and analgesia, and is a common sedative for procedural sedation in paediatric emergency departments (EDs) due to its non-parenteral administration and good safety profile. [1][2][3] Suitable procedures include fracture reduction, toilet and suturing, incision and drainage, and application of burn dressings. The concentration of N 2 O administered ranges from 30-70%, with maximum effect at 5 minutes, and rapid recovery upon discontinuation. 1,4 Co-administered medications include intranasal fentanyl (1.5μg/kg, maximum 100μg/dose) administered 30-60 minutes prior to enhance analgesia, 3 oral analgesics, topical anaesthesia or parenteral morphine.Although N 2 O is commonly used globally, there is no published report on its effectiveness and safety in paediatric patients in Singapore. We seek to identify the effectiveness of N 2 O as a form of procedural sedation and analgesia for children requiring painful procedures in a tertiary paediatric emergency department (ED), study the incidence of adverse events, and evaluate the safety of co-administered opioids.A retrospective analysis was performed on all patients less than 18 years who underwent procedural sedation with N 2 O as a primary agent from 1 April 2013 to 31 September 2021, at the ED of KK Women's and Children's Hospital, Singapore. A prospective electronic database of all procedural sedations performed at the ED was set up in April 2013. All sedation-related adverse events and interventions were prospectively documented in the sedation forms in the medical records and extracted into the database. Data on demographics, diagnosis, procedures, types of sedatives, other co-administered medications, adverse events, and interventions were electronically extracted from the database. N 2 O concentration, flow rate, start and end times, and sedation depth (Children's Hospital of Wisconsin Sedation Scale) 5 were extracted manually from electronic medical records. The Children's Hospital of Wisconsin Sedation Scale has a scale of 0-6, with 6 being agitated. Data were anonymised in passwordprotected Excel (Microsoft Corp, Redmond, US) file.Statistical analyses were performed using SPSS Statistics version 28.0 (IBM Corp, Armonk, US). Categorical variables were analysed using Fisher's

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confidence: 53%

Safety and effectiveness of nitrous oxide procedural sedation in a paediatric emergency department

Tan

Tham

2023

Ann Acad Med Singap

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“…In 2019, Seiler et al (28) proved that there were no differences with regard to the analgesic efficacy, sedation depth and rate of AE of procedural analgo-sedation (PAS) in patients treated with N 2 O 70% with and without IN fentanyl.…”

Section: Fentanylmentioning

confidence: 99%

Intranasal drugs for analgesia and sedation in children admitted to pediatric emergency department: a narrative review

Pansini¹,

Curatola²,

Gatto³

et al. 2021

Ann Transl Med

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Acute pain is one of the most common symptoms in children admitted to the Pediatric Emergency Department (PED) and its management represents a real clinical challenge for pediatricians.Different painful procedures can be very stressful for young children and their perception of pain can be enhanced by emotional factors, such as anxiety, distress, or anger. Adequate procedural sedation reduces anxiety and emotional trauma for the patient, but it reduces also stress for operators and the time for procedures. We have reviewed the literature on this topic and the drugs covered in these papers were: midazolam, fentanyl, ketamine, and dexmedetomidine. There are several routes of administering for these drugs to provide analgesia and anxiolysis to children: oral, parenteral, or intranasal (IN). Intravenous (IV) sedation, since it involves the use of needles, can be stressful; instead, IN route is a non-invasive procedure and generally well tolerated by children and it has become increasingly widespread. Some medications can be administered by a mucosal atomizer device (MAD) or by drops. The benefits of the atomized release include less drug loss in the oropharynx, higher cerebrospinal fluid levels, better patient acceptability, and better sedative effects. IN midazolam has a sedative, anxiolytic and amnesic effect, but without analgesic properties.Fentanyl and ketamine are mainly used for pain control. Dexmedetomidine has anxiolytic and analgesic properties. In conclusion, IN analgo-sedation is a simple, rapid and painless option to treat pain and anxiety in the PED requiring brief training on the administration process and experience in sedation.

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“…In these settings, no safety concerns were reported and IN fentanyl was found to be effective for early pain relief. Numerous studies have demonstrated the safety and efficacy of IN fentanyl in physician-directed protocols, including procedural sedation ( 8 , 9 , 13 , 14 ). However, previous studies reported data limited to children >3 years.…”

Section: Discussionmentioning

confidence: 99%

Safety of nurse-directed triage intranasal fentanyl protocol for acute pain management in a European pediatric emergency department: A retrospective observational analysis

et al. 2023

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BackgroundNurse-directed pain protocols for intranasal fentanyl administration are not widely implemented in European (EU) pediatric emergency departments (PED). Barriers include perceived safety concerns for intranasal (IN) fentanyl. The aim of this study is to describe our experience with a nurse-directed triage IN fentanyl protocol with a focus on safety in a tertiary EU PED.MethodsWe conducted a retrospective analysis of patient records of children aged 0–16 years who received nurse-directed IN fentanyl between January 2019 and December 2021 at the PED of the University Children's Hospital of Bern, Switzerland. Extracted data points included demographics, presenting complaint, pain score, IN fentanyl dosage, concomitant pain medication use, and adverse events.ResultsA total of 314 patients were identified with ages ranging from 9 months to 15 years. The main indication for nurse-directed fentanyl administration was musculoskeletal pain due to trauma (n = 284, 90%). Mild adverse events (vertigo) were reported in two patients (0.6%), without a correlation to concomitant pain medication or protocol violation. The only reported severe adverse event of syncope and hypoxia in a 14-year-old adolescent occurred in a setting where the institutional nurse-directed protocol was violated.ConclusionIn accordance with previous studies outside of Europe, our data support the case that when appropriately used, nurse-directed IN fentanyl is a safe potent opioid analgesic for pediatric acute pain management. We strongly encourage the introduction of nurse-directed triage fentanyl protocols Europe-wide in order to provide effective and adequate acute pain management in children.

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Combined nitrous oxide 70% with intranasal fentanyl for procedural analgosedation in children: a prospective, randomised, double-blind, placebo-controlled trial

Cited by 10 publications

References 23 publications

Safety and effectiveness of nitrous oxide procedural sedation in a paediatric emergency department

Safety and effectiveness of nitrous oxide procedural sedation in a paediatric emergency department

Intranasal drugs for analgesia and sedation in children admitted to pediatric emergency department: a narrative review

Safety of nurse-directed triage intranasal fentanyl protocol for acute pain management in a European pediatric emergency department: A retrospective observational analysis

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