title: Removal of esophageal foreign bodies in the pediatric ED: is ketamine an option?
abstract: The objective of the study was to evaluate our experience with esophageal foreign body (EFB) removal comparing the use of ketamine-midazolam (K-M) and fentanyl-midazolam (F-M) in the emergency department (ED), to admission and general anesthesia (GA) in the operating room (OR). A retrospective review of all children undergoing EFB removal at our institution during a 2-year period was conducted. A total of 93 patients were identified: K-M 57/93 (61.2%), F-M 28/93 (30.1%), GA 5/93 (5.4%), and 3/93 (3.2%) by other means. Mean procedure durations were 4.8 min for K-M and 7.0 min for F-M. Mean lengths of stay (LOS) for ED procedures were 3.6 hrs for K-M and 5.7 hrs for F-M, versus 17.7 hrs if admitted. Transient hypoxemia occurred in 10.7% of K-M and 15.4% of F-M. Removal of EFBs in the ED may obviate the need for admission. In our experience, the use of K-M is associated with fewer airway complications, shorter removal times, and an overall shorter LOS.
authors.affiliation: Department of Pediatrics, Division of Emergency Medicine, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA. hostetler_m@kids.wustl.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hostetler
authors.forename: John A
authors.initials: JA
authors.lastname: Barnard
mesh_terms: D000761:Anesthesia Department, Hospital; D000778:Anesthetics, Dissociative; D002675:Child, Preschool; D016292:Procedural Sedation; D004636:Emergency Service, Hospital; D004947:Esophagus; D005260:Female; D005547:Foreign Bodies / Q000601:surgery*; D006801:Humans; D007649:Ketamine; D007902:Length of Stay; D008297:Male
chemical_list: D000778:Anesthetics, Dissociative; D007649:Ketamine