Behavioral Changes in Children Are Uncommon 4 Weeks After Procedural Sedation and Analgesia With Intranasal...

Painful procedures requiring sedation and analgesia are commonly performed in pediatric emergency departments. However, there is little knowledge about the possible delayed effects of procedural sedation and analgesia on children's behavior. The aim of the current study was to examine children's behavioral changes 4 weeks after procedural sedation and analgesia with intranasal dexmedetomidine and nitrous oxide. Parents of the children who participated in a clinical trial comparing intranasal dexmedetomidine and nitrous oxide for procedural sedation and analgesia during painful procedures were interviewed 4 weeks after procedural sedation and analgesia. The Post Hospitalization Behavior Questionnaire was used for the parental interviews by phone to evaluate changes in children's behavior. Behavioral changes were reported in 13 of 128 (10.2%) children, of which eight experienced negative behavioral changes and five positive changes. Young age was associated with negative behavioral changes; median age was 5.7 years in children with negative behavioral changes and 9.4 years in children with no behavioral changes (p-value 0.0062). Children with negative behavioral changes were less likely to accept the same method for procedural sedation and analgesia in the future (p-value 0.049) as were their parents (p-value 0.012). Parents of children with negative behavioral changes were less satisfied with the general management of procedural sedation and analgesia than parents whose children did not experience negative changes (p-value 0.024). No association with higher pain scores during the procedure and negative behavioral changes was seen. Behavioral changes are uncommon 4 weeks after procedural sedation and analgesia with intranasal dexmedetomidine or nitrous oxide for painful procedures such as fracture reduction.