title: Etomidate Versus Ketamine: Effective Use in Emergency Procedural Sedation for Pediatric Orthopedic Injuries.
abstract: OBJECTIVE
  The aim of this study was to compare the induction and recovery times, postsedation observation durations, and adverse effects of etomidate and ketamine in pediatric patients with fractures and/or dislocations requiring closed reduction in the emergency department.
  
  
  METHODS
  Forty-four healthy children aged 7 to 18 years were included. The patients were randomly divided into 2 groups. Group 1 (24 patients) received etomidate and fentanyl, and group 2 (20 patients) received ketamine intravenously. The Ramsay Sedation Scale and American Pediatric Association discharge criteria were used to evaluate the patients.
  
  
  RESULTS
  There were 70 fractured bones and 3 joint dislocations. Except in 1 case (2.3%), all of the injuries were reducted successfully. The mean amount of drugs used to provide adequate sedation and analgesia were 0.25 mg/kg of etomidate and 1.30 μg/kg of fentanyl in group 1 and 1.25 mg/kg of ketamine in group 2. Fourteen patients (31.8%) reported adverse effects, and none required hospitalization. There was no difference between the groups in the recovery times, occurrence of adverse effects, and postsedation observation durations (P > 0.05). The mean (SD) induction time for the patients in group 1 was 4.3 (1.0) minutes, whereas it was 2.2 (1.6) minutes in group 2 (P < 0.001).
  
  
  CONCLUSIONS
  Etomidate induces effective and adequate sedation in the pediatric emergency department for painful orthopedic procedures. Ketamine, which has longer action times, might be preferred for reductions because orthopedic procedures could be lengthy.
authors.affiliation: *From the Department of Emergency Medicine, †Division of Pediatric Emergency Medicine, Department of Pediatrics, and ‡Department of Biostatistics, Çukurova University Faculty of Medicine; §Emergency Clinic, Adana Training and Research Hospital, Başkent University; and ║Emergency Clinic, Adana Numune Training and Research Hospital, Adana, Turkey.
authors.forename: Nezihat Rana
authors.initials: NR
authors.lastname: Dişel
authors.forename: Hayri Levent
authors.initials: HL
authors.lastname: Yilmaz
authors.forename: Yaşar
authors.initials: Y
authors.lastname: Sertdemir
authors.forename: Hasan
authors.initials: H
authors.lastname: Yeşilağaç
authors.forename: Akkan
authors.initials: A
authors.lastname: Avci
mesh_terms: D000293:Adolescent; D002648:Child; D054810:Deep Sedation / Q000379:methods*; D004636:Emergency Service, Hospital; D005045:Etomidate / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D005592:Fracture Fixation / Q000379:methods; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D004204:Joint Dislocations / Q000601:surgery*; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D007649:Ketamine; D005283:Fentanyl; D005045:Etomidate