Pediatric Procedural Sedation and Analgesia

Sedation with the Combination of Ketamine and Propofol in a Pediatric ED: A Retrospective Case Series Analysis

“…Procedural sedation and analgesia (PSA) administered by pediatric emergency physicians for pain control and anxiolysis is well established [1,2]. The combination of ketamine and propofol has gained popularity in recent years because the drugs are thought to complement one another [2][3][4][5][6][7].…”

Paediatric procedural sedation within the emergency department

“…Emergency department (ED) practitioners should recognise higher risk patients in planning PSA. For example, the 4‐tier Malampati score has been used in anaesthesia to predict a difficult airway . Higher scores (Class III and IV) predict difficult bag–valve–mask ventilation and risk of airway obstruction .…”

“…For example, the 4‐tier Malampati score has been used in anaesthesia to predict a difficult airway . Higher scores (Class III and IV) predict difficult bag–valve–mask ventilation and risk of airway obstruction . A degree of patient cooperation is required to use the Malampati score.…”

“…Although serious adverse events are rare, PSA must be safe, and sedation providers should be prepared to intervene should complications occur. Cote and Hoffman demonstrated that patient selection, adherence to a prescribed process and minimisation of the number of sedating agents were important in reducing PSA risks.…”

Intravenous Ketamine Bolus: Not So Fast!

“…The recovery times also appear comparable to those of other short-and ultrashort-acting sedative hypnotics. 6 The total sedation time is significantly shorter than the 64 to 78 minutes reported by other double-blind, randomized, controlled trials that used 1 to 1.5 mg/kg of ketamine administered more slowly. 7,8 The median total sedation time was also lower than the 45 minutes reported for the subset of patients who received a single dose of ketamine.…”