Emergency Physician–Administered Propofol Sedation: A Report on 25,433 Sedations From the Pediatric Sedation Research Consortium

Paediatric procedural sedation at a tertiary care university teaching hospital in India

“…These findings are similar to what has been published previously 5,11,15 . Additionally patients with a diagnosis of cerebral palsy were at a higher risk of AE and this is consistent with findings from other studies especially with use of midazolam which has been to shown to give rise to agitation and delayed recovery 19 .…”

“…Serious AE rate was however low (1.2%) compared to other studies and could be attributed to the type of medications used in our study (i.e. no propofol) 15 . None of the patients had aspiration, required cardiopulmonary resuscitation or died.…”

“…Interestingly no opioids, barbiturates or any sedative infusions were utilized in this study. The use of a single bolus rather than an infusion of the sedative could also explain the lower success rate compared to studies that utilize propofol or ketamine which report much higher procedure success rates 15,16 . It is possible that due to the fear attributed to ketamine's side effect profile especially laryngospasm, the paediatricians were reluctant to use that as a first line agent for non-radiology procedures 17,18 .…”

“…This higher incidence of AE in patients with cerebral palsy could be attributed to multiple factors such as muscle tone, pharyngeal collapse, increased secretions and drug interactions with various medications used daily such as baclofen 20 . We excluded all patients with a recent active upper respiratory infection as sedation candidates as there are some publications which have elucidated to the higher risk of adverse events and sedation failure in these patients 21] The risk for AE in our patients with prematurity, gastrooesophageal reflux disease and cardiac disease was not statistically significant, although studies have shown that these patients are at higher risk for AE with sedation 15,22,23,24 . This study has several limitations.…”

Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems

“…195,196 Published reports involving adult patients and recently published experiences with children demonstrate that, when applied using careful protocols and in a setting of experienced sedation teams, propofol, either alone or in combination with ketamine, can be used safely and effectively for sedation in children. 195,[197][198][199][200][201][202][203][204][205] Benzodiazepines, particularly rapidly effective but relatively short-acting ones, such as midazolam, are also helpful in the prehospital and ED settings. Nitrous oxide is a potent analgesic that does not require venous access and is available in some EDs.…”