title: Conscious sedation for pediatric orthopaedic emergencies.
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.
authors.affiliation: Section of General and Emergency Pediatrics, University of Colorado School of Medicine, Denver, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Graff
authors.forename: R M
authors.initials: RM
authors.lastname: Kennedy
authors.forename: D M
authors.initials: DM
authors.lastname: Jaffe
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000009:adverse effects*; D004630:Emergencies; D005260:Female; D005283:Fentanyl / Q000009:adverse effects* / Q000494:pharmacology; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D007223:Infant; D004204:Joint Dislocations / Q000628:therapy*; D008297:Male; D008349:Manipulation, Orthopedic; D008874:Midazolam / Q000009:adverse effects* / Q000494:pharmacology; D008991:Monitoring, Physiologic; D012119:Respiration / Q000187:drug effects; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D008874:Midazolam; D005283:Fentanyl