Related Experiment Videos
Conscious sedation for pediatric orthopaedic emergencies
K J Graff1, R M Kennedy, D M Jaffe
1Section of General and Emergency Pediatrics, University of Colorado School of Medicine, Denver, USA.
Insights
Conscious sedation with fentanyl and midazolam for pediatric fracture reduction had few, minor complications. Female sex and deep sedation were linked to increased respiratory events, highlighting the need for careful monitoring.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Sedation Management
Background:
- Conscious sedation (CS) is frequently used in pediatric emergency departments for painful procedures.
- Fentanyl and midazolam are common agents for CS, but their safety profile requires ongoing evaluation.
- Implementing standardized protocols is crucial for safe CS administration.
Purpose of the Study:
- To evaluate the safety and efficacy of conscious sedation using fentanyl and midazolam for fracture and dislocation reductions in children.
- To identify risk factors associated with complications during pediatric CS.
- To assess the effectiveness of a newly implemented CS protocol.
Main Methods:
- Retrospective review of 339 pediatric patients undergoing CS for fracture/dislocation reduction over 22 months.
- Data collected via standardized CS forms, analyzed using descriptive statistics and inferential tests (chi-squared, Fisher's exact, t-test, logistic regression).
- Assessment of complications, including respiratory status changes, vomiting, and need for interventions.
Main Results:
- The majority of patients (339) experienced minor complications, with 11.0% having altered respiratory status.
- Most respiratory events were mild, requiring minimal intervention (e.g., oxygen, breathing reminders, airway maneuvers).
- Female sex (OR=2.2) and deep sedation (OR=2.7) were associated with increased risk of respiratory events; no patients required intubation or admission due to CS complications.
Conclusions:
- Fentanyl and midazolam administered via protocol for pediatric CS are associated with a low rate of minor complications.
- Female patients and those experiencing deep sedation may have a slightly higher risk of respiratory alterations.
- Continuous monitoring of vital signs is essential for ensuring patient safety during conscious sedation.
Abstract:
The objective of this study was to assess complications and risk factors among children undergoing conscious sedation (CS) with fentanyl (F) and midazolam (M) for reduction of fractures and dislocations. A 22-month retrospective review was made of an urban pediatric emergency department's records after implementing a CS protocol for the administration of F/M. Data collection was facilitated by standard CS forms, and data were analyzed using descriptive statistics, chi 2 analysis, Fisher's exact test, t test, odds ratio, and logistic regression. A total of 339 children (65% boys), mean age of 8.4 years, were enrolled in the study. The mean time to sedation was 11.3 +/- 6.2 minutes and to discharge was 92 +/- 36.3 minutes. The mean total doses of M and F were 0.17 +/- 0.08 mg/kg and 1.5 +/- 0.8 micrograms/kg, respectively. An alteration in respiratory status occurred in 37 (11.0%) patients: 28 (8.3%) had oxygen saturation < 90%; 16 (4.7%) received oxygen; 12 (3.6%) were given verbal breathing reminders, eight (2.4%) received airway positioning maneuvers, and 2 (0.6%) received naloxone. Four patients (1.2%) vomited. None required assisted ventilation, intubation, or admission resulting from complications of CS. Characteristics associated with the respiratory events included female sex (odds ratio = 2.2) and deep sedation (odds ratio = 2.7). We conclude that complications associated with F/M administered by protocol were few, minor, and easily managed. Patients who are female or who enter a state of deep sedation may be at modestly increased risk for alterations in respiratory status. Careful attention to monitoring vital functions on all patients is necessary to provide safe CS.