title: Sedation for children with intraoral injuries in the emergency department: a case-control study.
abstract: OBJECTIVE
  Intraoral procedures (IOPs) are performed within the oral cavity of a spontaneously breathing, deeply sedated child. The objective of this study was to retrospectively evaluate the safety of sedation for IOP in a pediatric emergency department.
  
  
  METHODS
  An unmatched, case-control study was conducted. The records of patients who had an IOP between January 1, 2012, and December 31, 2012, were analyzed. We evaluated the rate of serious adverse events during sedation (SAEDS) in patients who had an IOP (case subjects) and in patients who had a closed reduction of a forearm fracture (controls) and compared the 2 cohorts.
  
  
  RESULTS
  Forty-one study subjects and 38 controls had complete records. Demographic characteristics were similar for both groups. Cases and controls were treated with the combination of propofol-ketamine for most of the cases (30/41 [73.2%] and 32/38 [84.2%]), and doses were similar between the groups. Study subjects had 5 hypoxic events and 2 apneic events; controls had 4 hypoxic events and 2 apneic events. No aspiration events were recorded. There were no statistically significant differences in the rate of SAEDS between the 2 groups (P = 0.55 and P = 0.54, respectively). All SAEDS were successfully managed in the emergency department, and no patient required hospitalization due to an adverse reaction.
  
  
  CONCLUSIONS
  Findings of this study suggest that when performed by a skilled provider, sedation for an IOP is as safe as sedation for a fracture reduction.
authors.affiliation: From the *Pediatric Emergency Department, Rambam Health Care Campus; †Rappaport Faculty of Medicine, Technion-Institute of Technology; ‡Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel; and §Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Itai
authors.initials: I
authors.lastname: Shavit
authors.forename: Noam
authors.initials: N
authors.lastname: Bar-Yaakov
authors.forename: Lelah
authors.initials: L
authors.lastname: Grossman
authors.forename: Giora
authors.initials: G
authors.lastname: Weiser
authors.forename: Ruth
authors.initials: R
authors.lastname: Edry
authors.forename: Ivan P
authors.initials: IP
authors.lastname: Steiner
mesh_terms: D016022:Case-Control Studies; D002648:Child; D054810:Deep Sedation / Q000009:adverse effects; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D009055:Mouth / Q000293:injuries* / Q000601:surgery*; D012189:Retrospective Studies