Sedation with ketamine, propofol, and dexmedetomidine in pediatric emergency departments

Describe current practices and variation in procedural sedation with ketamine, propofol and dexmedetomidine in pediatric emergency departments (EDs).

This was a retrospective study of 40 hospitals in the Pediatric Health Information System from 2016 to 2022, including ED visits for children under 18 years old who received sedation with ketamine, propofol, or dexmedetomidine. We described institutional variation in choice of sedation medication, as well as the differences in both frequency and diagnoses associated with procedural sedation by age.

There were 189,086 ED encounters included in the study. Ketamine was given in 177,502 (94 %) encounters, propofol in 22,916 (12 %), and dexmedetomidine in 3240 (1.7 %). Ketamine was the primary medication used in nearly all institutions, with only a few outliers using propofol or dexmedetomidine. The highest number of sedations occurred in young children (aged 1-7 years), and the number of ED sedation encounters decreased with each year of age beyond 5 years. Notably, infants under 1 year of age were infrequently sedated (1.4 % of all sedations). The most common diagnoses associated with sedation encounters were fractures/dislocations (60 %), followed by lacerations (19 %), and abscesses (5.8 %). Diagnoses varied with age; fractures/dislocations were more common in older age groups, while lacerations and abscesses were disproportionately more common in younger children.

In nearly all institutions, use of ketamine was far more common than use of propofol or dexmedetomidine. The most common diagnoses associated with ED sedation were orthopedic injuries, though diagnoses varied with age. These results illustrate current sedation practices with ketamine, propofol and dexmedetomidine in the pediatric ED and may inform future standardization efforts.