Management of acute pain and anxiety in children undergoing procedures in the emergency department

Abstract

This CME activity is intended for physicians who provide sedation and analgesia for procedures in the emergency department; including pediatricians, emergency physicians, and pediatric emergency physicians. LEARNING OBJECTIVES1. List the three most common indications for procedural sedation and analgesia (PSA) in the ED. 2. Describe the four general classes of agents used for PSA and their available routes of administration. 3. Discuss the potential adverse effects and contraindications to the use of PSA agents and antagonists. 4. Explain the different indications for topical anesthetics in PSA. 5. Discuss the future directions in pediatric PSA research and clinical practice.

Pediatric procedural pain

“…120 Thorough review of procedural sedation and analgesia is beyond the scope of this article; readers are referred to excellent recent reviews of this topic. 14,113,121 …”

Reducing Anxiety in the Pediatric Emergency Department: A Comparative Trial

“…When hospitals do employ behavioral strategies, they are often reserved for children in the pre- and peri-procedural settings [6–11]. Unfortunately, the psychosocial needs of many patients who have SA while being in a PED are not adequately addressed.…”

Procedural Sedation for Children With Special Health Care Needs

“…If a diagnostic study or procedure requiring sedation is anticipated, specific information on the child's baseline physical findings, medications, allergies, last meal, neurologic problems, respiratory status, medication reactions, operative procedures, tolerance to anesthesia, and past unusual drug reactions should be solicited. [2][3][4][5][6][7] An American Society of Anesthesiologists (ASA) classification should be assigned to any patient undergoing procedural sedation. 5,6 The ASA classification criteria are summarized in Table 1.…”