Minimal Sedation Use for Laceration Repair in the Pediatric Emergency Department

Minimal sedation agents assist pediatric laceration repair, but few studies compare their efficacy and safety in the emergency department (ED). They can be preferred agents by mildly impairing cognitive function and physical coordination while maintaining important airway, ventilatory, and cardiovascular functions.

To determine procedure completion and reported adverse events (AEs) between minimal sedation agents for facial laceration repair in the ED.

This retrospective study included children 1-8 years of age who received minimal sedation (oral [PO] or intranasal [IN] midazolam, IN dexmedetomidine, or PO hydrocodone-acetaminophen) for sutured facial laceration repair. The primary outcome was procedure completion, with secondary outcomes of reported AEs and time metrics.

1309 eligible patients met inclusion criteria with procedural completion achieved in 95.5% (1250/1309). AEs were documented in 21 patients (1.6%) without significant difference by medication. Hydrocodone-acetaminophen had a shorter ED length of stay by an average of approximately 40 min compared to the other three medications combined after adjustment (aβ = -38.86 (-48.31 to -29.41). The use of IN midazolam reduced time from medication administration to ED disposition by approximately 20 min (aβ = -20.16 (95% CI -25.17 to -15.14).

Minimal sedation agents allow for successful facial laceration repair in children and AEs were rarely reported. The quality of sedation with these agents was not studied but would be beneficial for future studies.