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Ketamine-propofol combination sedation for fracture reduction in the pediatric emergency department
Ghazala Q Sharieff1, Douglas R Trocinski, John T Kanegaye
1Division of Emergency Medicine, Rady Children's Hospital and Health Center, 3020 Children's Way (MC 5075), San Diego, CA 92123-4282, USA. ghazalaqs@hotmail.com
Insights
Intravenous ketamine-propofol sedation effectively and safely managed pediatric forearm fracture reductions. This combination ensured rapid recovery and minimal complications in the emergency department setting.
Area of Science:
- Pediatric Emergency Medicine
- Anesthesiology
- Orthopedic Surgery
Background:
- Forearm fractures are common pediatric injuries requiring procedural sedation for reduction.
- Optimizing sedation protocols is crucial for patient safety and procedural success in emergency settings.
Purpose of the Study:
- To assess the efficacy, safety, onset, and recovery times of intravenous ketamine-propofol sedation for pediatric forearm fracture reductions.
- To evaluate this sedation combination in a pediatric emergency department environment.
Main Methods:
- A prospective, observational pilot study involving children undergoing closed reduction of forearm fractures.
- Administration of ketamine (0.5 mg/kg) and propofol (1 mg/kg) intravenously.
- Measurement of sedation and recovery intervals, procedural success, and complications, with follow-up surveys.
Main Results:
- Successful reduction in 19 of 20 patients.
- Median times: 5 minutes to reduction, 10 minutes to response, 38 minutes to discharge suitability.
- Favorable ratings for sedation and ease of reduction; mild complications (hypoxia, vomiting, ataxia) without serious adverse events.
Conclusions:
- Ketamine-propofol combination offers effective sedation for pediatric forearm fracture reduction.
- Rapid recovery and a favorable safety profile were observed in this pilot study.
- This sedation strategy is a viable option for managing pediatric fractures in the emergency department.
Objectives:
To evaluate the time of onset and recovery from and the efficacy and safety of intravenous ketamine-propofol sedation for reduction of forearm fractures in the pediatric emergency department setting.
Study Design:
Prospective, observational pilot study.
Methods:
Children presenting to an urban pediatric emergency department requiring sedation for closed reduction of forearm fractures received ketamine 0.5 mg/kg and propofol 1 mg/kg. We measured time intervals from drug administration to reduction, recovery, and attainment of discharge criteria, and obtained ratings of depth of sedation, pain, and ease of reduction. A follow-up survey elicited patient recall, parental satisfaction, and delayed complications. Complications were recorded during the procedure and by chart review.
Results:
Reduction was successful in 19 of 20 patients with one requiring open reduction. Median time intervals measured from initiation of ketamine injection were 5 minutes to reduction completion, 10 minutes to first purposeful response, and 38 minutes to suitability for discharge. Three patients recalled reduction or casting, but in no case was reduction reported to be the most painful aspect of visit. Emergency physicians and orthopedic residents rated sedation and ease of reduction favorably. Complications included mild hypoxia, vomiting, and transient ataxia. No apnea, hemodynamic compromise, dysphoria, or injection pain occurred.
Conclusions:
In this pilot study, the combination of ketamine and propofol provided effective sedation with rapid recovery and no clinically significant complications for children requiring closed reduction of forearm fractures.
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