What are the indications for the use of pediatric sedation in the emergency department (ED)?

Updated: May 08, 2018
  • Author: Wan-Tsu Wendy Chang, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Answer

Answer

The function of sedation is management of anxiety, pain, and control of excessive motion. Diagnostic procedures for which emergency department (ED) sedation may be indicated include the following:

  • Arthrocentesis

  • Bone marrow biopsy

  • Sexual assault examination

  • Radiologic evaluation (computed tomography [CT], magnetic resonance imaging [MRI])

Therapeutic procedures for which ED sedation may be indicated include the following:

  • Suturing

  • Wound care

  • Abscess incision and drainage

  • Fracture reduction

  • Dislocation

  • Foreign body removal

  • Burn debridement

  • Tube thoracostomy

  • Any other painful procedure

Procedural sedation is commonly used in major procedures (eg, fracture reduction), but it should also be considered when multiple procedures (eg, intravenous [IV] line placement, lumbar puncture, and urethral catheterization) are being performed on a child. Procedural sedation avoids the need for prolonged restraint and lessens the stress of the procedure on the patient and family members. [1]

Use of anesthetic agents in the ED continues to be an issue at many institutions. To minimize controversy, it is advantageous to anticipate and manage adverse reactions. Many problems can be avoided if individuals with advanced airway skills are immediately available, skilled personnel are present to monitor the patient, appropriate monitoring devices are used, and written policies and procedures are in place.

Many hospitals have a credentialing process that helps to ensure knowledge of the procedure. In many institutions, the ED pharmacopeia is restricted, and specific agents (eg, ketamine, propofol) are unavailable or are approved for use only by anesthesiologists.


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