Etomidate for Short Pediatric Procedures in the Emergency Department
| Autor: | Mark G. Roback, Joseph Wathen, Jeffrey L. Galinkin, Maria Mandt, Dexiang Gao, Lalit Bajaj |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Male
Adolescent Sedation Conscious Sedation Loading dose Fentanyl Fractures Bone Etomidate medicine Humans Prospective Studies Child Adverse effect Prospective cohort study Capnography medicine.diagnostic_test business.industry General Medicine Emergency department Child Preschool Anesthesia Pediatrics Perinatology and Child Health Emergency Medicine Female medicine.symptom Emergency Service Hospital business Anesthetics Intravenous medicine.drug |
| Zdroj: | Pediatric Emergency Care. 28:898-904 |
| ISSN: | 0749-5161 |
| Popis: | Objective This study aimed to prospectively determine the etomidate dose associated with adequate sedation and few significant respiratory events for procedures of short duration in children. Methods This is a prospective cohort study in an urban pediatric emergency department of patients 4 to 18 years requiring sedation and analgesia for painful procedures of short duration. Patients received fentanyl 1 μg/kg followed by intravenously administered etomidate 0.1 to 0.2 mg/kg as a loading dose. An additional dose of etomidate 0.1 mg/kg was intravenously administered if needed. The level of sedation was determined by The Children's Hospital of Wisconsin Sedation Score. The primary outcome was to determine the etomidate dose associated with an adequate level of sedation and procedural completion. Results Sixty patients were enrolled. The most frequent procedure was fracture reduction (50/60, 83.3%). Procedures were successfully completed for 59 (98.3%) of 60 patients. The initial dose of etomidate associated with adequate sedation was 0.2 mg/kg intravenously administered for 33 (66.7%) of 50 patients requiring fracture reduction and for 6 (60.0%) of 10 patients receiving a procedure other than fracture reduction. Respiratory depression was noted in 9 (16.4%) of 55 patients, and oxygen desaturation was noted in 23 (39.0%) of 59 patients. Of 58 patients, 21 (36.2%) experienced a respiratory adverse event requiring brief intervention including oxygen supplementation, stimulation, and/or airway repositioning. No patient experienced a significant adverse respiratory event, defined as positive pressure ventilation. Median time to discharge-ready was 21 minutes. Conclusions For short-duration painful emergency department procedures, etomidate 0.2 mg/kg intravenously administered after fentanyl was associated with effective sedation, successful procedural completion, and readily managed respiratory adverse events in children. |
| Databáze: | OpenAIRE |
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