Eric Scheier1, Chen Gadot2, Ronit Leiba3, Itai Shavit4. 1. Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel. 2. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. 3. Quality of Care Unit, Rambam Health Care Campus, Haifa, Israel. 4. Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel. Electronic address: i_shavit@rambam.health.gov.il.
Abstract
BACKGROUND: Literature to date has suggested advantages of sedation with the combination of ketamine and propofol over ketamine alone or propofol alone. However, there is a paucity of data regarding sedation with the combination of ketamine and propofol in pediatric emergency medicine. METHODS: A retrospective case series analysis of children who underwent sedation with the combination of ketamine and propofol in a pediatric emergency department was conducted. Study covariates were extracted from the emergency department medical records. RESULTS: Four hundred twenty-nine patients, 297 males and 132 females, with a median age of 6.8 years (interquartile range, 3.9-10.9 years), underwent sedation by pediatric emergency physicians. Serious adverse events during sedation (SAEDS) were recorded in 52 procedures (12.1%), which included 39 hypoxic events (9.1%), 12 apneic events (2.8%), and 1 laryngospasm (0.2%). All SAEDS were managed successfully, and no child underwent intubation because of an adverse reaction or required hospitalization. Multivariate logistic regression analysis did not reveal any association between age, weight, fasting time, analgesic medication provided before sedation, length of procedure, capnography use, dosages of medications, and the presence of SAEDS. CONCLUSIONS: This is the largest reported series of sedation with the combination of ketamine and propofol in pediatric emergency medicine. Findings suggest that sedation with the combination of ketamine and propofol can be safely performed by a skilled emergency physician.
BACKGROUND: Literature to date has suggested advantages of sedation with the combination of ketamine and propofol over ketamine alone or propofol alone. However, there is a paucity of data regarding sedation with the combination of ketamine and propofol in pediatric emergency medicine. METHODS: A retrospective case series analysis of children who underwent sedation with the combination of ketamine and propofol in a pediatric emergency department was conducted. Study covariates were extracted from the emergency department medical records. RESULTS: Four hundred twenty-nine patients, 297 males and 132 females, with a median age of 6.8 years (interquartile range, 3.9-10.9 years), underwent sedation by pediatric emergency physicians. Serious adverse events during sedation (SAEDS) were recorded in 52 procedures (12.1%), which included 39 hypoxic events (9.1%), 12 apneic events (2.8%), and 1 laryngospasm (0.2%). All SAEDS were managed successfully, and no child underwent intubation because of an adverse reaction or required hospitalization. Multivariate logistic regression analysis did not reveal any association between age, weight, fasting time, analgesic medication provided before sedation, length of procedure, capnography use, dosages of medications, and the presence of SAEDS. CONCLUSIONS: This is the largest reported series of sedation with the combination of ketamine and propofol in pediatric emergency medicine. Findings suggest that sedation with the combination of ketamine and propofol can be safely performed by a skilled emergency physician.
Authors: Maala Bhatt; David W Johnson; Jason Chan; Monica Taljaard; Nick Barrowman; Ken J Farion; Samina Ali; Suzanne Beno; Andrew Dixon; C Michelle McTimoney; Alexander Sasha Dubrovsky; Nadia Sourial; Mark G Roback Journal: JAMA Pediatr Date: 2017-10-01 Impact factor: 16.193
Authors: Mathew Clark; Esma Birisci; Jordan E Anderson; Christina M Anliker; Micheal A Bryant; Craig Downs; Abdallah Dalabih Journal: Anesth Essays Res Date: 2016 Sep-Dec