Intravenous Sedation and Analgesia in a Pediatric Emergency Department: A Retrospective Descriptive Study

Area of Science:

• Pediatric Emergency Medicine
• Pharmacology
• Anesthesiology

Background:

• Painful procedures in pediatric emergency departments necessitate sedation and analgesia for children and adolescents.
• Ensuring adequate pain control is a fundamental right for pediatric patients undergoing medical interventions.

Purpose of the Study:

• To describe the utilization of procedural sedation and analgesia with intravenous medications in a pediatric emergency department.
• To analyze the types of interventions, medications used, and adverse events associated with sedoanalgesia.

Main Methods:

• Retrospective descriptive study conducted in a level II district hospital's pediatric emergency department (October 2018 - December 2023).
• Analysis of data from 615 pediatric patients who received intravenous sedoanalgesia.
• Review of intervention types, administered drugs (ketamine, midazolam, propofol, morphine), and recorded adverse events.

Main Results:

• The study included 615 patients (65.7% male, median age 6 years).
• Most common procedures were wound suturing (50.9%) and fracture reduction (36.3%).
• Ketamine (99.2%) and midazolam (95.8%) were the primary drugs, often in combination (93.8%). Adverse events occurred in 8.1% of patients, with transient oxygen desaturation being most frequent. Respiratory complications resolved without invasive measures. Sedation was primarily administered by pediatric intensivists (68.1%).

Conclusions:

• Intravenous sedoanalgesia, especially the ketamine-midazolam combination, is a safe and effective method for pediatric procedural sedation.
• The study highlights a low incidence of adverse events, with no dose-dependency observed.
• Effective pain management and sedation were achieved for painful procedures in the pediatric emergency setting.