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Adverse events during sedation for oro-dental trauma in an Israeli paediatric emergency department

Leon Bilder1, Simona Librov2, Zvi Gutmacher3

  • 1Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel.

Dental Traumatology : Official Publication of International Association for Dental Traumatology
|October 26, 2021
PubMed

Insights

Ketamine-propofol (KP) sedation for pediatric dental trauma in the emergency department (ED) had a high rate of adverse events. Intramuscular ketamine alone was safer for sedating children with oro-dental injuries.

Area of Science:

  • Emergency Medicine
  • Pediatric Dentistry
  • Anesthesiology

Background:

  • Limited data exists on the safety of sedation for pediatric oro-dental trauma in emergency departments (EDs).
  • Previous studies indicated intramuscular ketamine as a safe single-agent sedation for this population.
  • A tertiary trauma center in Israel utilizes two ketamine-based sedation regimens for intraoral injuries: intramuscular ketamine or intravenous ketamine-propofol (KP).

Purpose of the Study:

  • To evaluate the safety of intravenous ketamine-propofol (KP) sedation for children undergoing emergency oro-dental injury treatment.
  • To identify and compare sedation adverse events requiring intervention (SAERI) among different sedation methods.

Main Methods:

  • A retrospective study conducted over two years in a pediatric ED.
  • Compared SAERI in children sedated with intravenous ketamine-propofol (KP), intramuscular ketamine, or nitrous oxide.
  • SAERI included prolonged oxygen desaturation, apnea, laryngospasm, hypotension, bradycardia, airway obstruction, and aspiration.

Main Results:

  • No SAERI were reported in the intramuscular ketamine group (n=20).
  • One SAERI (3.4%) occurred in the nitrous oxide group (n=29).
  • Six out of 17 patients (35%) sedated with intravenous ketamine-propofol (KP) experienced SAERI.

Conclusions:

  • Intravenous ketamine-propofol (KP) sedation for pediatric oro-dental injuries in the ED is associated with a high incidence of adverse events requiring intervention.
  • Caution is advised when using KP sedation for young children with oro-dental injuries in the emergency setting.
  • Intramuscular ketamine appears to be a safer alternative for sedation in this patient population.

Keywords:
childrendentalinjuriesketamineoralsedation

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