Etomidate versus midazolam for procedural sedation in pediatric outpatients: a randomized controlled trial.
OBJECTIVE
Midazolam is widely used for procedural sedation and analgesia. Etomidate has been studied mostly in adults. Our objective is to compare the efficacy of etomidate and midazolam for achieving procedural sedation and analgesia in children.


METHODS
A randomized, double-blind, emergency department and orthopedic clinic-based trial was carried out among patients aged 2 to 18 years with displaced extremity fractures. Patients were administered 1 microg/kg of fentanyl and either 0.2 mg/kg of etomidate or 0.1 mg/kg of midazolam. Adequate sedation was defined, for the purpose of this study, as a score of 4 or more on the Ramsay Sedation Scale. The primary outcome was induction and recovery time. The rates of adverse events, success of fracture reduction, and parent and physician satisfaction were also compared.


RESULTS
From April to August 2004, 100 of 128 eligible patients were enrolled (age 8.7+/-3.7 years; 50% male patients). A higher proportion of patients attained adequate sedation among those who received etomidate: 46 of 50 (92%) versus 18 of 50 (36%) (delta 56%; 95% confidence interval [CI] 38% to 69%). Time taken for induction (hazard ratio 4.9; 95% CI 2.2 to 10.9) and time taken for recovery (hazard ratio 2.8; 95% CI 1.5 to 5.1) were lower among patients who received etomidate. The rates of adverse events were similar in both groups, except for myoclonus and pain at the injection site, which was more frequent in the etomidate group.


CONCLUSIONS
Induction and recovery times are shorter with etomidate compared with midazolam. At the dosages used for procedural sedation and analgesia among children with displaced extremity fracture, etomidate has higher efficacy in comparison with midazolam.
Di Liddo
Lydia
L
Division of Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Ste-Justine, Montréal, Quebec, Canada. diliddolydia@hotmail.com
D'Angelo
Antonio
A
Nguyen
Bao
B
Bailey
Benoit
B
Amre
Devendra
D
Stanciu
Constantin
C
D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003258:Consumer Behavior; D004311:Double-Blind Method; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005045:Etomidate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D005596:Fractures, Closed / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000860:Hypoxia / Q000139:chemically induced; D008297:Male; D008349:Manipulation, Orthopedic; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009207:Myoclonus / Q000139:chemically induced; D009985:Orthopedics; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010290:Parents / Q000523:psychology; D010549:Personal Satisfaction; D010820:Physicians / Q000523:psychology; D011446:Prospective Studies; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl; D005045:Etomidate