Are kids normally super angry after procedural sedations

[Angry Birds]

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I’ve done so many procedural sedations in my career and don’t remember kids being super angry when they come out of sedation.

My own kiddo had a procedure and came out super angry.

So is this normal? Do I just miss it since I don’t usually come back to check on patients after the procedure is done?

And any tips to make them less angry when they come out of it?

 

[Apollyon]

Was that with ketamine? Sounds like the "emergence phenomenon", a/k/a a "bad trip".

 

[norski]

I've seen a few paradoxical responses in emergence with midazolam in children. Super hyper and more or less delirious. I like intranasal dexmedetomidine.

 

[wareagle726]

Weird you ask. I've done hundreds of sedations with ketamine(don't know if that's what your kid had) but last week I had a routine one and the kid did fine until about 10 mins after the procedure and turned into the hulk. Pissed off at the world. First time that has ever happened to me in a kid. In retrospect I stopped at about 0.5 mg/kg which is in that danger zone of 0.3-0.7/kg because he was out. I think that probably caused an emergence reaction. Lasted about an hour.

 

[Rekt]

Weird you ask. I've done hundreds of sedations with ketamine(don't know if that's what your kid had) but last week I had a routine one and the kid did fine until about 10 mins after the procedure and turned into the hulk. Pissed off at the world. First time that has ever happened to me in a kid. In retrospect I stopped at about 0.5 mg/kg which is in that danger zone of 0.3-0.7/kg because he was out. I think that probably caused an emergence reaction. Lasted about an hour.

This doesn’t make sense. You shouldn’t be titrating ketamine to effect. Either you give pain dose at 0.3mg/kg or you do IV 1-1.5mg/kg for sedation.

 

[Angry Birds]

Wasn’t ketamine. Was propofol and versed.

 

[BoardingDoc]

Paradoxical reaction to the versed maybe. The prop will wear off faster leaving just the versed onboard at the end. That said, who's doing moderate sedation with prop and versed these days? I've literally never done that. Prop and fent / Versed and fent / Prop and ketamine / etomidate and fent? Sure. Prop and versed? I'm sure it would work, I just don't understand why you would combine the two.