Paediatric procedural sedation based on nitrous oxide and ketamine: sedation registry data from Australia

Large, mainly North American, series has shown the safety of paediatric procedural sedation in the emergency department (ED). However, sedation practices elsewhere differ. This study set out to investigate the sedation practice and the associated adverse events profile at the largest Australian paediatric ED.

Review of a prospective single centre procedural sedation registry database at an urban tertiary children's hospital ED in Australia with an annual census of 67 000 patients over a 4-year period (2004-8). Sedation records were supplemented with medical record review. Patients 18 years and older were excluded. Demographics, agents used, adverse events and complications were analysed descriptively.

Over the 4-year period, 2002 patients underwent procedural sedation. The median age was 5.7 years. Nitrous oxide was used in 1625 (81%), ketamine in 335 (17%) and midazolam in 39 (2%). Propofol and chloral hydrate were used in two and one patient, respectively. Most sedations were for laceration repair (38%) and orthopaedic procedures (33%); 89% had no adverse events. Most adverse events were mild, mainly vomiting (8%). Serious adverse events were desaturation in 12 patients, seizures in two patients and chest pain in one patient. The maximum required airway support was bag mask ventilation. No patients aspirated or required intubation.

In variation to reported practice elsewhere, almost all procedures in this Australian series were undertaken using nitrous oxide and ketamine. The serious adverse events rate was low.