Related Experiment Videos
Intravenous sedation for the closed reduction of fractures in children
C D Varela1, K C Lorfing, T L Schmidt
1Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City 64108.
Insights
Intravenous sedation using a narcotic and benzodiazepine is safe and effective for pediatric fracture reduction. This method achieved high success rates and parent satisfaction with minimal complications.
Area of Science:
- Pediatric Anesthesiology
- Orthopedic Surgery
- Pharmacology
Background:
- Closed reduction of fractures in children often requires effective sedation.
- Assessing the safety and efficacy of combined narcotic and benzodiazepine intravenous sedation is crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of intravenous sedation with meperidine and midazolam for pediatric fracture closed reduction.
Main Methods:
- 104 children undergoing closed fracture reduction received intravenous sedation with meperidine and midazolam.
- Total of 110 procedures were analyzed, with detailed monitoring of vital signs and outcomes.
Main Results:
- High success rate of 92% for initial reductions.
- No cardiorespiratory complications or apnea observed.
- Excellent physician (94%) and parent (98%) satisfaction reported.
Conclusions:
- Intravenous sedation with a narcotic (meperidine) and benzodiazepine (midazolam) is a safe and effective anesthetic technique for pediatric fracture reduction.
- This method offers a favorable safety profile and high patient/parent satisfaction.
- Post-sedation monitoring remains essential for patient safety.
Abstract:
The safety and efficacy of intravenous sedation with both a narcotic and a benzodiazepine were evaluated in 104 consecutive children who had closed reduction of a fracture. Six patients had a subsequent additional reduction with intravenous sedation, so the study involved a total of 110 procedures. The average dose of meperidine was 1.47 milligrams per kilogram of body weight, and the average dose of midazolam was 0.11 milligram per kilogram of body weight. The interval between induction of the sedation and performance of the procedure averaged ten minutes, and the total duration of the procedure averaged thirty-nine minutes. There were no episodes of apnea or cardiorespiratory complications. Ninety-six (92 percent) of the initial 104 reductions were successful. Only four patients subsequently needed general anesthesia for a repeat closed reduction. The physician's satisfaction with the method of sedation was good or excellent for 103 (94 per cent) of the 110 procedures. Eighty-one (93 per cent) of eighty-seven patients who were able to respond had no memory of the reduction. A telephone survey conducted after the procedure revealed that eighty-four (98 per cent) of eighty-six parents who responded were satisfied with the method of sedation. Intravenous sedation with a narcotic and a benzodiazepine proved to be a safe and effective method of anesthesia for the closed reduction of fractures in children in our series. Careful monitoring of the patient after sedation is imperative.