Experience in procedural sedation and analgesia in a pediatrics emergency unit
Abstract
Introduction: painful procedures are gradually increasing frequency in pediatrics emergency units. Controlling pain and mitigating fear and anxiety are of the essence when assisting pediatric patients and one of the priorities of emergency doctors.
Objective: to describe using sedoanalgesia with ketamine and fentanyl as the only drug or associated with other drugs during painful procedures, at the Pediatrics Emergency Unit, of the Pereira Rossell Hospital Center.
Method: descriptive, retrospective study from January 2011 to July 2016. Population: all patients who received sedoanalgesia with ketamine and fentanyl (as the only drug or associated with other drugs) during painful procedures at the Pediatrics Emergency Unit, of the Pereira Rossell Hospital Center. Database: medical records. Effectiveness was measured by success of the procedure and safety in terms of adverse effects in connection with it.
Results: N=352 children younger than 15 years old. 96 received ketamine and 256 received fentanyl. Average age was 7 years old and 245 of them were boys. Average dose of ketamine was 1 mg/kg, average dose of fentanyl was 1 g/kg. Main indications for sedoanalgesia included: orthopaedic procedures (264), thoracentesis (62). Procedures were successful in 352 patients. 100% of cases involved cardiovascular monitoring and blood oxygen saturation meter. Adverse effects: 6 (no advanced life support manoeuvres required). No patient changed final destination.
Conclusions: the use of sedoanalgesia was effective and safe, when applied by emergengy pediatricians qualified in the handling of drugs and advanced life support. Monitoring during and after procedure is required to determine and solve complications at an early stage.
References
(2) Krauss B, Green SM. Procedural sedation and analgesia in children. Lancet 2006; 367(9512):766-80. Disponible en: www.thelancet.com [Consulta: 2 noviembre 2019]. doi:10.1016/S0140-6736(06)68230-5.
(3) Hartling L, Milne A, Foisy M, Lang E, Sinclair D, Klassen T, et al. What works and what’s safe in pediatric emergency procedural sedation: an overview of reviews. Acad Emerg Med 2016; 23:519-30.
(4) Doctor K, Roback M, Teach S. An update on pediatric hospital-based sedation. Curr Opin Pediatr 2013, 25:310-6. doi:10.1097/MOP.0b013e328360bb92.
(5) López JC, Soult JA. Analgesia y sedación en Pediatría. Pediatr Int 2006; 10(4):267-76.
(6) Anand KJ, Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med 1987; 317:1321-9.
(7) Lowrie L. Evolution of a medical discipline during a professional lifetime. En: Gooden C, Lowrie L, Jackson B, edits. The pediatric procedural sedation handbook. Londres: Oxford University Press, 2018:3-8.
(8) Capapé S, Benito FJ. Analgesia y sedación para procedimientos menores. En: Capapé S, edit. Manual de analgesia y sedación en urgencias de pediatría. 2a ed. Madrid: Ergon, 2012:175-82.
(9) Sacchetti A, Cortese T. Procedual sedation and analgesia. En: Fuchs S, Yamamoto L, edits. APLS: the pediatric emergency medicine resource. 5th ed. Miami: Jones and Bartlett Learning, 2012.
(10) Mason K, Seth N. The pearls of pediatric sedation: polish the old and embrace the new. Minerva Anestesiol 2019; 85(10):1105-17. doi: 10.23736/S0375-9393.19.13547-X.
(11) Cardozo A. Dolor y ansiedad. Analgesia y sedación en la emergencia. En: Bello O, Sehabiague G, Prego J, de Leonardis D. Pediatría: urgencias y emergencias. 3ª ed. Montevideo: BiblioMédica, 2009:207-22.
(12) de Leonardis D, Prego J, Bello O, Pujadas M. Analgesia y sedación en procedimientos ortopédicos dolorosos en la sala de urgencias pediátricas. Arch Pediatr Urug 2006; 77(4): 361-7.
(13) Fernaìndez Santervas Y, Gonzaìlez Herrero M, Duraìn Fernaìndez-Feijoo C. Analgesia sistémica. En: Capapé S, edit. Manual de analgesia y sedación en urgencias de pediatría. 2a ed. Madrid: Ergon, 2012:87-99.
(14) Adriaìn Gutieìrrez J, Miìguez Navarro C. Complicaciones de los procedimientos de sedacioìn y analgesia en urgencias pediaìtricas. En: Capapé S, edit. Manual de analgesia y sedación en urgencias de pediatría. 2a ed. Madrid: Ergon, 2012: 61-70.
(15) Green S, Roback M, Krauss B, Miner J, Schneider S, Kivela P, et al. Unscheduled procedural sedation: a multidisciplinary consensus practice guideline. Ann Emerg Med 2019; 73(5):e51-e65.
(16) Hartling L, Milne A, Foisy M, Lang E, Sinclair D, Klassen T, et al. What works and what’s safe in pediatric emergency procedural sedation: an overview of reviews. Acad Emerg Med 2016: 23(5):519-30.
(17) Coté CJ, Wilson S. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics 2019; 143(6):e20191000.
(18) Trottier E, Ali S, Le May S, Gravel J. Treating and reducing anxiety and pain in the paediatric emergency department: the TRAPPED survey. Paediatr Child Health 2015; 20(5):239-44.
(19) Clerigué N. Analgesia y sedación para procedimientos mayores dolorosos. En: Capapé S, edit. Manual de analgesia y sedación en urgencias de pediatría. 2a ed. Madrid: Ergon, 2012:183-200.
(20) Tsze DS, Reynolds J. Intranasal medications. En: Gooden C, Lowrie L, Jackson B, edits. The pediatric procedural sedation handbook. Londres: Oxford University Press, 2018.
(21) Therapeutic intranasal drug delivery. Needleless treatment options for medical problems. Disponible en: www.intranasal.net [Consulta: 24 setiembre 2019].
(22) Thackeray EM, Johnson KB. Airway rescue during sedation: a proposed airway rescue pathway for nonanesthesiologists. 2019; 32(4):464-71.
(23) Grunwell JR, Travers C, McCracken CE, Scherrer PD, Stormorken AG, Chumpitazi CE, et al. Procedural sedation outside of the operating room using ketamine in 22,645 children: a report from the pediatric sedation research consortium. Pediatr Crit Care Med 2016; 17(12):1109-16.
(24) Bellolio MF, Puls HA, Anderson JL, Gilani Wi, Murad MH, Barrionuevo P, et al. Incidence of adverse events in paediatric procedural sedation in the emergency department: a systematic review and meta-analysis. BMJ Open 2016; 6:e011384. doi:10.1136/bmjopen-2016-011384.
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