Annals of Emergency Medicine
Volume 54, Issue 2 , Pages 191-197.e4 , August 2009

Procedural Sedation and Analgesia Outcomes in Children After Discharge From the Emergency Department: Ketamine Versus Fentanyl/Midazolam

  • Alisa McQueen, MD

      Affiliations

    • Section of Pediatric Emergency Medicine, The University of Chicago, Chicago, IL
    • Corresponding Author InformationAddress for correspondence: Alisa McQueen, MD, The University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637; 773-702-0858, fax 773-702-0414
    • ,
  • Robert O. Wright, MD, MPH

      Affiliations

    • Department of Environmental Health, Harvard School of Public Health, Boston, MA
    • Division of Emergency Medicine, Children's Hospital and Harvard Medical School, Boston, MA
    • ,
  • Maya M. Kido, MD

      Affiliations

    • Case Western Reserve University School of Medicine, Cleveland, OH
    • ,
  • Erica Kaye, BA

      Affiliations

    • Harvard Medical School, Boston, MA
    • ,
  • Baruch Krauss, MD, EdM

      Affiliations

    • Division of Emergency Medicine, Children's Hospital and Harvard Medical School, Boston, MA

Received 5 July 2008 ,Revised 19 April 2009 ,Accepted 22 April 2009.

References 

  1. Krauss B, Green SM. Sedation and analgesia for procedures in children. N Engl J Med. 2000;342:938–945
  2. Pena BM, Krauss B. Adverse events of procedural sedation and analgesia in a pediatric emergency department. Ann Emerg Med. 1999;34(4 pt 1):483–491
  3. Pitetti R, Davis PJ, Redlinger R, et al. Effect on hospital-wide sedation practices after implementation of the 2001 JCAHO procedural sedation and analgesia guidelines. Arch Pediatr Adolesc Med. 2006;160:211–216
  4. Green SM, Rothrock SG, Harris T, et al. Intravenous ketamine for pediatric sedation in the emergency department: safety profile with 156 cases. Acad Emerg Med. 1998;5:971–976
  5. Green SM, Rothrock SG, Lynch EL, et al. Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1,022 cases. Ann Emerg Med. 1998;31:688–697
  6. Mamula P, Markowitz JE, Neiswender K, et al. Safety of intravenous midazolam and fentanyl for pediatric GI endoscopy: prospective study of 1578 endoscopies. Gastrointest Endosc. 2007;65:203–210
  7. Krauss B, Green SM. Procedural sedation and analgesia in children. Lancet. 2006;367:766–780
  8. Sherwin TS, Green SM, Khan A, et al. Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures? (a randomized, double-blind, placebo-controlled trial). Ann Emerg Med. 2000;35:229–238
  9. Wathen JE, Roback MG, Mackenzie T, et al. Does midazolam alter the clinical effects of intravenous ketamine sedation in children? (a double-blind, randomized, controlled, emergency department trial). Ann Emerg Med. 2000;36:579–588
  10. Kain ZN, Caldwell-Andrews AA, Maranets I, et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg. 2004;99:1648–1654table of contents
  11. Kain ZN, Sevarino F, Pincus S, et al. Attenuation of the preoperative stress response with midazolam: effects on postoperative outcomes. Anesthesiology. 2000;93:141–147
  12. Agrawal D, Manzi SF, Gupta R, et al. Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department. Ann Emerg Med. 2003;42:636–646
  13. Vernon DT, Schulman JL, Foley JM. Changes in children's behavior after hospitalization (Some dimensions of response and their correlates). Am J Dis Child. 1966;111:581–593
  14. Thompson RH, Vernon DT. Research on children's behavior after hospitalization: a review and synthesis. J Dev Behav Pediatr. 1993;14:28–35
  15. Vernon DT, Thompson RH. Research on the effect of experimental interventions on children's behavior after hospitalization: a review and synthesis. J Dev Behav Pediatr. 1993;14:36–44
  16. Stargatt R, Davidson AJ, Huang GH, et al. A cohort study of the incidence and risk factors for negative behavior changes in children after general anesthesia. Paediatr Anaesth. 2006;16:846–859
  17. Patel A, Schieble T, Davidson M, et al. Distraction with a hand-held video game reduces pediatric preoperative anxiety. Paediatr Anaesth. 2006;16:1019–1027
  18. Karling M, Stenlund H, Hagglof B. Behavioural changes after anaesthesia: validity and liability of the Post Hospitalization Behavior Questionnaire in a Swedish paediatric population. Acta Paediatr. 2006;95:340–346
  19. Calipel S, Lucas-Polomeni MM, Wodey E, et al. Premedication in children: hypnosis versus midazolam. Paediatr Anaesth. 2005;15:275–281
  20. Keaney A, Diviney D, Harte S, et al. Postoperative behavioral changes following anesthesia with sevoflurane. Paediatr Anaesth. 2004;14:866–870
  21. Kain ZN, Mayes LC, Caldwell-Andrews AA, et al. Sleeping characteristics of children undergoing outpatient elective surgery. Anesthesiology. 2002;97:1093–1101
  22. Kain ZN, Wang SM, Mayes LC, et al. Distress during the induction of anesthesia and postoperative behavioral outcomes. Anesth Analg. 1999;88:1042–1047
  23. Watson AT, Visram A. Children's preoperative anxiety and postoperative behaviour. Paediatr Anaesth. 2003;13:188–204
  24. Marx CM, Stein J, Tyler MK, et al. Ketamine-midazolam versus meperidine-midazolam for painful procedures in pediatric oncology patients. J Clin Oncol. 1997;15:94–102
  25. Evans D, Turnham L, Barbour K, et al. Intravenous ketamine sedation for painful oncology procedures. Paediatr Anaesth. 2005;15:131–138
  26. Newman DH, Azer MM, Pitetti RD, et al. When is a patient safe for discharge after procedural sedation? (the timing of adverse effect events in 1367 pediatric procedural sedations). Ann Emerg Med. 2003;42:627–635
  27. Kennedy RM, Porter FL, Miller JP, et al. Comparison of fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic emergencies. Pediatrics. 1998;102(4 pt 1):956–963
  28. Godambe SA, Elliot V, Matheny D, et al. Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department. Pediatrics. 2003;112(1 pt 1):116–123
  29. Luhmann JD, Kennedy RM, Porter FL, et al. A randomized clinical trial of continuous-flow nitrous oxide and midazolam for sedation of young children during laceration repair. Ann Emerg Med. 2001;37:20–27
  30. Kain ZN, Mayes LC, Wang SM, et al. Postoperative behavioral outcomes in children: effects of sedative premedication. Anesthesiology. 1999;90:758–765
  31. Roback MG, Wathen JE, Bajaj L, et al. Adverse events associated with procedural sedation and analgesia in a pediatric emergency department: a comparison of common parenteral drugs. Acad Emerg Med. 2005;12:508–513
  32. Langston WT, Wathen JE, Roback MG, et al. Effect of ondansetron on the incidence of vomiting associated with ketamine sedation in children: a double-blind, randomized, placebo-controlled trial. Ann Emerg Med. 2008;52:30–34
  33. Roback MG, Wathen JE, MacKenzie T, et al. A randomized, controlled trial of i.v. versus i.m. ketamine for sedation of pediatric patients receiving emergency department orthopedic procedures. Ann Emerg Med. 2006;48:605–612

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 Supervising editor: Steven M. Green, MD

 Author contributions: AM and BK conceived and designed the study. AM, MMK, EK, and BK recruited patients, conducted the follow-up interviews, and managed the data. ROW assisted with study design and analyzed the data. AM drafted the article, and all authors contributed substantially to its revision. AM takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication date: Available online May 20, 2009.

 Reprints not available from the authors.

PII: S0196-0644(09)00406-5

doi: 10.1016/j.annemergmed.2009.04.015

Annals of Emergency Medicine
Volume 54, Issue 2 , Pages 191-197.e4 , August 2009

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