Safety of procedural sedation and analgesia in children less than 2 years of age in a pediatric emergency department.
BACKGROUND
Although young age is considered a risk factor for adverse events related to procedural sedation and analgesia (PSA), data in very young children (<2 years of age) are lacking.


OBJECTIVE
The main objective of our study is to describe PSA in children <2 years of age in an inner city tertiary care pediatric emergency department (PED).


METHODS
We conducted a retrospective chart review from January 2005 to June 2007 of children <2 years of age who received PSA in our PED. We collected demographic variables, indication for and medications used for PSA, adverse events (AE) related to PSA, and interventions performed to treat them.


RESULTS
Of the children who received PSA, 14.5% (180/1,235) were <2 years of age of whom 173 were included for the analysis; 73% (126/173) of the study subjects were between 1 and 2 years of age, 54.3% (94/173) were male, and 96.5% (167/173) belonged to American Society of Anesthesiologists class 1. Incision and drainage (45.0%, 78/173) and laceration repair (32.4%, 56/173) were the two most common indications for PSA. Ketamine and midazolam was the most common combination medication used for PSA (62.4%, 108/173). Sedation was deemed ineffective in 5.8% (10/173) of the children. There were only two failed sedations; 5.8% (10/173) of the children experienced AE with most being minor [oxygen desaturations 1.7% (3/173), emesis 2.3% (4/173), and others 1.2% (2/173)]. One child experienced serious AE in the form of apnea and bradycardia requiring intubation.


CONCLUSIONS
Our data suggest that children under 2 years of age can be sedated effectively without increased risk of AE in a PED.
Misra
Shailendra
S
Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI 48201, USA.
Mahajan
Prashant V
PV
Chen
Xinguang
X
Kannikeswaran
Nirupama
N