Sedation and analgesia for minor pediatric procedures

Algren, John T.; Algren, Chris L.

doi:10.1097/00006565-199612000-00013

Cited by 21 publications

(10 citation statements)

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“…The successful completion of painful procedures in children within the emergency department (ED) requires the child to remain still and cooperative. Children have a more intense physical and emotional reaction to painful or threatening procedures than do adults and it is important to offer a combination of distraction, analgesia and sedation in a safe manner 1–4 …”

Section: Introductionmentioning

confidence: 99%

Ketamine sedation for children in the emergency department

et al. 2001

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Objective: To introduce a protocol for dissociative sedation using ketamine for children requiring painful procedures within the emergency department. Method: A medical literature search was performed along with a review of existing ketamine‐use protocols in emergency departments from Australia and the United States. Our hospital anaesthetic department and our emergency department nursing staff were closely involved in protocol design. A series of nursing education sessions were held prior to the drug being used within the emergency department. Twenty‐eight children aged 1.5–12 years were administered ketamine sedation prior to undergoing a painful procedure. Ketamine was administered either i.m. (dose 3–4 mg/kg) or i.v. (dose 1.00–2.75 mg/kg) depending on physician preference. Midazolam (dose 0.02 mg/kg) and atropine (dose 0.02 mg/kg) were given as adjuncts in the majority of cases. Results: Onset of sedation was rapid (range 1–7 min) for both routes and provided excellent procedural conditions. Discharge time averaged 103 min (range 67–180 min) from time of drug administration. Side‐effects included vomiting, rash, diplopia, salivation and one case of a distressing emergence reaction. On telephone follow up 1–3 days after the sedation, no delayed adverse events were reported. Conclusion: Ketamine is a safe and effective sedative agent for use in children requiring immobilization to enable performance of a painful procedure. It is important to involve both anaesthetic staff and emergency department nursing staff in sedation protocol development to ensure a smooth introduction. We present a protocol for ketamine use in children undergoing painful procedures within the emergency department. See Commentary, page 7.

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Section: Introductionmentioning

confidence: 99%

Ketamine sedation for children in the emergency department

et al. 2001

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“…combination have been recommended to achieve satisfactory sedation and/or analgesia. [1][2][3][4] Yet, no drug or technique is absolutely safe or completely reliable. [4][5][6] Because of a concern for safety, many children are often inadequately sedated and are immobilized primarily by physical restraint to complete the diagnostic study.…”

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confidence: 99%

Comparison of Intravenous Midazolam with Pentobarbital for Sedation for Head Computed Tomography Imaging

Moro-Sutherland

Algren

Louis

et al. 2000

Academic Emergency Medicine

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Abstract. Objective:To compare the efficacy of intravenous (IV) midazolam with that of IV pentobarbital when used for sedation for head computed tomography (CT) imaging in emergency department (ED) pediatric patients. Methods: Prospective, randomized clinical trial in an urban children's hospital. During a two-and-a-half-year period, 55 patients were enrolled: 34 males and 21 females. Measurements included induction time, recovery time, efficacy, side effects, complications, and failure with each drug. Success of sedation was graded as good (GS), adequate (AS), poor (PS), or unsuccessful (US). Results: Sedation for CT was used for patients with the following problems: head trauma (21/55), central nervous system pathology (17/55), ventriculoperitoneal shunt evaluation (6/55), periorbital cellulitis (6/55), and retropharyngeal abscess (5/55). Twenty-nine (53%) patients received pentobarbital (mean Ϯ SD dose 3.75 Ϯ 1.10 mg/kg) and 26 (47%) patients received midazolam (mean Ϯ SD dose 0.2 Ϯ 0.03 mg/ kg). In the pentobarbital group, 28 (97%) patients were scanned and successfully sedated. Pentobarbital's mean induction time was 6 minutes and duration of sedation averaged 86 minutes. In the midazolam group, only five (19%) patients were successfully scanned with midazolam alone. Of the 21 (81%) patients given midazolam who were unsuccessfully sedated, 12 (61%) were subsequently sedated with the addition of pentobarbital for completion of CT imaging. Mild oxygen desaturation, O 2 sat >90% yet <94%, was seen in only four patients. All four patients responded to blow-by oxygen and required no other intervention. Conclusion: Intravenous pentobarbital is more effective than IV midazolam for sedation of children requiring CT imaging.

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“…Before a procedure, preparatory age appropriate information about the procedure, including an explanation of what the child is likely to feel should increase the understanding of children and parents and reduce stress and anxiety. 10 During the procedure the child should be given verbal encouragement and sweeping statements such as "it won't hurt" should be avoided. 11 Children may perceive their injury or illness as punishment for some disobedience and further pain in the A&E department may reinforce this.…”

Section: Psychological Methods Of Pain Reliefmentioning

confidence: 99%