Sedatives used in children to obtain head CT in the emergency department

Burger, Rebecca K.; Figueroa, Janet; McCracken, Courtney; Mallory, Michael D.; Kamat, Pradip

doi:10.1016/j.ajem.2020.02.035

Cited by 10 publications

(12 citation statements)

References 14 publications

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“…Study designs included 11 RCTs, 22,32–41 13 cohort studies and other nonrandomized studies, 19–21,23,42–50 and 11 case series and case reports 12,51–60 . Six of the included studies were conference abstracts 20,21,40,47,50,56 .…”

Section: Resultsmentioning

confidence: 99%

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The use of dexmedetomidine in the emergency department: A systematic review

Baumgartner

Groff

Yaeger

et al. 2022

Academic Emergency Medicine

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Sedatives, anxiolytics, and analgesics are near-ubiquitous interventions during daily care in the emergency department (ED). The agents most commonly used to treat intubated patients include sedatives acting on the gamma-aminobutyric acid (GABA) receptor, such as benzodiazepines and propofol, as well as the opioid analgesic fentanyl. Benzodiazepines are highly deliriogenic 1 and may prolong duration of mechanical ventilation and length of stay. 2 Propofol can be associated with significant hypotension and with a life-threatening

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Section: Resultsmentioning

confidence: 99%

“…Study designs included 11 RCTs, 22,[32][33][34][35][36][37][38][39][40][41] 13 cohort studies and other nonrandomized studies, [19][20][21]23,[42][43][44][45][46][47][48][49][50] and 11 case series and case reports. 12,[51][52][53][54][55][56][57][58][59][60] Six of the included studies were conference abstracts.…”

Section: Study Characteristicsmentioning

confidence: 99%

The use of dexmedetomidine in the emergency department: A systematic review

Baumgartner

Groff

Yaeger

et al. 2022

Academic Emergency Medicine

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“…응급실에서 컴퓨터단층촬영이 필요한 영유아 두부외상 환자에게 진정 및 진통 요법(procedural sedation and analgesia, PSA)을 시행하는 목적은 환자의 움직임 및 불안을 최소화하여, 질 좋은 영상을 얻기 위함이다 [1][2][3] . 하지만, 단층촬영 스캐너의 기술적 향상에 따른 촬영시간 단축, 촬영 시 보호자 동반에 따른 환자의 안정감, PSA 전담 인력 부족, 응급실 과밀화 위험으로 인해, 그 대안이 필요한 상황도 있다.…”

Section: 서론unclassified

Potential benefit of a screening tool in selecting head-injured children aged 36 months or younger who can cooperate in computed tomography

Kim¹,

Kim²,

Lee³

et al. 2021

Pediatr Emerg Med J

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Purpose: We aimed to investigate the benefit of a screening tool in selecting head-injured children who can potentially cooperate with computed tomography (CT).Methods: The study population consisted of head-injured children aged 36 months or younger who visited the emergency department (ED) and underwent CT from January 2013 through December 2020. Procedural sedation and analgesia (PSA) using per os chloral hydrate or per rectal thiopental was implemented to children presumed less cooperative for CT as per a clinical screening tool for cooperative candidates for CT (e.g., ability to lie still on bed for 10 seconds without a guardian). According to the PSA and the first attempt success of CT, we compared baseline characteristics, CT findings, clinically important traumatic brain injury, ED length of stay (EDLOS), and ED disposition.Results: Among the 247 children, PSA was used in 102 (41.3%). The PSA group showed a higher proportion of 3-36 months of age (PSA, 96.1% vs. non-PSA, 82.8%; P = 0.001) and longer median EDLOS (PSA, 127.0 [interquartile range, 101.0-172.0] vs. non-PSA, 85.0 minutes [63.0-130.0]; P < 0.001). The number of children undergoing the first attempt success was 213 (86.2%) without a difference in both groups (PSA, 84.3% vs. non-PSA, 87.6%; P = 0.645). In the 213 children, the implementation of PSA was associated with longer median EDLOS (PSA, 121.0 [99.0-156.0] vs. non-PSA, 77.0 minutes [60.0-122.0]; P < 0.001). In the non-PSA group (n = 145), the first attempt failure was associated with the presence of skull fracture (success, 7.1% vs. failure, 27.8%; P = 0.009).Conclusion: This study suggests a potential benefit of the screening tool in selecting cooperative candidates for CT, i.e., those who could forgo PSA using oral chloral hydrate or per rectal thiopental, in young children with head injury.

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“…They reported a sedating efficacy of 60–75% for midazolam in most trials versus 80–95% for the other drugs. The only other rectal option appears to be pentobarbital, which was the third most used sedative for head computerized tomography in children in 2017 in the US (cohort of n = 24,418 patients [ 10 ]. Apart from the US, pentobarbital in the rectal form is also used in France, but it has not been used in the UK since its withdrawal in the 1960s due to its potential for abuse [ 11 ] and therefore is not mentioned in the NICE Sedation in children and young people guideline, updated in 2019 [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Development and Stability of a New Formulation of Pentobarbital Suppositories for Paediatric Procedural Sedation

et al. 2023

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Pentobarbital is a drug of choice to limit motion in children during paediatric procedural sedations (PPSs). However, despite the rectal route being preferred for infants and children, no pentobarbital suppositories are marketed, and therefore they must be prepared by compounding pharmacies. In this study, two suppository formulations of 30, 40, 50, and 60 mg of pentobarbital sodium were developed using hard-fat Witepsol® W25 either alone (formulation F1) or with oleic acid (formulation F2). The two formulations were subjected to the following tests described in the European Pharmacopoeia: uniformity of dosage units, softening time, resistance to rupture, and disintegration time. The stability of both formulations was also investigated for 41 weeks of storage at 5 ± 3 °C using a stability-indicating liquid chromatography method to quantify pentobarbital sodium and research breakdown product (BP). Although both formulae were compliant to uniformity of dosage, the results were in favour of a faster disintegration of F2 compared to F1 (−63%). On the other hand, F1 was found to be stable after 41 weeks of storage unlike F2 for which several new peaks were detected during the chromatographic analysis, suggesting a shorter stability of only 28 weeks. Both formulae still need to be clinically investigated to confirm their safety and efficiency for PPS.

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Sedatives used in children to obtain head CT in the emergency department

Cited by 10 publications

References 14 publications

The use of dexmedetomidine in the emergency department: A systematic review

The use of dexmedetomidine in the emergency department: A systematic review

Potential benefit of a screening tool in selecting head-injured children aged 36 months or younger who can cooperate in computed tomography

Development and Stability of a New Formulation of Pentobarbital Suppositories for Paediatric Procedural Sedation

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