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Etomidate Versus Ketamine: Effective Use in Emergency Procedural Sedation for Pediatric Orthopedic Injuries
Nezihat Rana Dişel1, Hayri Levent Yilmaz, Yaşar Sertdemir
1*From the Department of Emergency Medicine, †Division of Pediatric Emergency Medicine, Department of Pediatrics, and ‡Department of Biostatistics, Çukurova University Faculty of Medicine; §Emergency Clinic, Adana Training and Research Hospital, Başkent University; and ║Emergency Clinic, Adana Numune Training and Research Hospital, Adana, Turkey.
Insights
Etomidate and ketamine provide effective sedation for pediatric orthopedic procedures, with no significant differences in recovery or adverse effects. Ketamine demonstrated faster induction times compared to etomidate.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Orthopedic Surgery
Background:
- Sedation is crucial for pediatric orthopedic procedures in emergency departments.
- Comparing sedative agents like etomidate and ketamine is essential for optimizing patient care.
Purpose of the Study:
- To compare etomidate and ketamine for sedation in pediatric patients undergoing fracture or dislocation reduction.
- To evaluate induction/recovery times, observation durations, and adverse events.
Main Methods:
- 44 healthy children (7-18 years) randomly received either etomidate/fentanyl or ketamine intravenously.
- Ramsay Sedation Scale and American Pediatric Association criteria were used for evaluation.
Main Results:
- Both agents achieved successful reduction in 97.7% of cases.
- No significant differences were found in recovery times, adverse effects, or observation durations.
- Ketamine had a significantly shorter mean induction time (2.2 min) compared to etomidate (4.3 min).
Conclusions:
- Etomidate is effective for sedation during painful pediatric orthopedic procedures.
- Ketamine may be preferred for lengthy procedures due to its longer action profile.
Objectives:
The aim of this study was to compare the induction and recovery times, postsedation observation durations, and adverse effects of etomidate and ketamine in pediatric patients with fractures and/or dislocations requiring closed reduction in the emergency department.
Methods:
Forty-four healthy children aged 7 to 18 years were included. The patients were randomly divided into 2 groups. Group 1 (24 patients) received etomidate and fentanyl, and group 2 (20 patients) received ketamine intravenously. The Ramsay Sedation Scale and American Pediatric Association discharge criteria were used to evaluate the patients.
Results:
There were 70 fractured bones and 3 joint dislocations. Except in 1 case (2.3%), all of the injuries were reducted successfully. The mean amount of drugs used to provide adequate sedation and analgesia were 0.25 mg/kg of etomidate and 1.30 μg/kg of fentanyl in group 1 and 1.25 mg/kg of ketamine in group 2. Fourteen patients (31.8%) reported adverse effects, and none required hospitalization. There was no difference between the groups in the recovery times, occurrence of adverse effects, and postsedation observation durations (P > 0.05). The mean (SD) induction time for the patients in group 1 was 4.3 (1.0) minutes, whereas it was 2.2 (1.6) minutes in group 2 (P < 0.001).
Conclusions:
Etomidate induces effective and adequate sedation in the pediatric emergency department for painful orthopedic procedures. Ketamine, which has longer action times, might be preferred for reductions because orthopedic procedures could be lengthy.
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