title: Sedation for peritonsillar abscess drainage in the pediatric emergency department.
abstract: OBJECTIVE
  To evaluate the use of intravenous (IV) sedation in children during peritonsillar abscess (PTA) incision and drainage in the emergency department (ED).
  
  
  METHODS
  Retrospective review of medical records of children with a diagnosis of PTA.
  
  
  METHODS
  The ED of a large, urban, academic children's hospital.
  
  
  METHODS
  Consecutive patients 18 years or younger presenting from April 1995 to November 1998.
  
  
  METHODS
  Information was retrieved from a time-based sedation record that included age, sex, ASA classification, time since last liquid or solid, agent and dose, level of sedation (A=alert, V=response to voice, P=purposeful response to pain, U=unresponsive), vital signs, complications, recovery time, and disposition.
  
  
  RESULTS
  Forty-two patients had incision and drainage performed with IV sedation in the ED. Mean age was 11.3 +/- 4.3 years (range 4-18 years); 57% were African-American, and 64% were female. Agents used included ketamine plus midazolam (K/M) (n = 36, 86%), morphine plus midazolam (n = 3, 7%), meperidine plus midazolam (n = 2, 5%), and nitrous oxide plus midazolam (n = 1, 2%). No cardiorespiratory complications, including laryngospasm, occurred. Vomiting occurred in 1 patient who received meperidine and midazolam. The deepest level of sedation reached included: 12% A, 64% V, and 24% P. No patient who had an abscess drained in the ED with IV sedation was admitted, and mean recovery time was 81.0 +/- 30.1 minutes.
  
  
  CONCLUSIONS
  IV sedation in children for incision and drainage of PTA by skilled personnel in the ED may eliminate the need for admission and surgical drainage in the operating room. K/M was used most frequently, without adverse effect, and all patients were discharged from the ED. Because K/M may result in deep sedation, appropriate personnel and equipment must be present.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, Missouri 63110, USA.
authors.forename: Jan D
authors.initials: JD
authors.lastname: Luhmann
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kennedy
authors.forename: John D
authors.initials: JD
authors.lastname: McAllister
authors.forename: David M
authors.initials: DM
authors.lastname: Jaffe
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D000039:Peritonsillar Abscess / Q000628:therapy*; D012189:Retrospective Studies