Pediatric procedural sedation

[Aesculapius]

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Two quick questions for you all:

1. What procedures do you routinely use procedural sedation for in kids?
2. What agent/agents do you usually use?

 

[Hercules]

1. Anything painful (certain lac repairs, some I&Ds, LPs, fracture reductions, chest tubes). Depends on age of child as well.
2. Propofol or ketamine mainly.

 

[em1234]

1. same as above
2. ketamine almost always, infrequently propofol.

 

[deuist]

For facial lacs I use intra-nasal versed.

 

[dchristismi]

Totally depends on the kid.

I love ketamine, but have used propofol as well.

There is something to be said for LET + Bubbleguppies on an ipad. I put a 5 year old's fingertip back on with just that.
I can sew faces with LET + Spongebob as well. But it sort of depends on the kid.

Thrashing 6 year old gets ketamine. Cooperative 8 year old might just get talked through it.

 

[RustedFox]

I regularly sedate children for examination with a good firm grip and a stern look. Should they not comply, I just simply hold them 'harder'.


Nah, I'm teasing. But in all seriousness, I have to say: I don't have intranasal versed or propofol, or ketmaine at my shop. I'm missing out.

 

[TooMuchResearch]

I regularly sedate children for examination with a good firm grip and a stern look. Should they not comply, I just simply hold them 'harder'.


Nah, I'm teasing. But in all seriousness, I have to say: I don't have intranasal versed or propofol, or ketmaine at my shop. I'm missing out.

Not having propofol or ketamine available would really harsh my buzz.

 

[e30ftw]

my residency peds ED has great "social" support (ipads, child life etc) and with LET, ipads, and maybe a little brutane for the crazies, most lacs are done w/o sedation.

large abscesses, all ortho, toddler->school aged LPs etc get sedated.

we use ketamine and propofol together (ketofol) a lot, and I like it.. appropriate bolus of both then titrate sedation with propofol, generally produces great sedation.

 

[RPedigo]

Kid is cooperative but anxious (e.g., high anxiety, low pain procedure such as a laceration or an LP): intranasal midazolam 0.3 mg/kg
Kid needs to be put out: ketamine

We also just got the SEDARA nitrous oxide mixing machine that does 50/50 oxygen and nitrous oxide which I have yet to try, but will give it a shot soon... may be useful for lacerations or I&D in conjunction with analgesia

 

[Tiger26]

-Lacs: LET + distraction (TV or ipad) works great--don't think I've fully sedated a kid of any age for a lac in the last 2 years or so
-LPs: topical anesthetics work great (LMX, EMLA) applied before. Usually when the patient comes in, I put these on--you can always wipe them off if you decide not to do the LP. As above, I frequently do these with the patient watching TV
-Fracture reduction: usually ketamine
-Abscesses: same with topical anesthetics + distraction, but these occassionally get sedated

On all of these, intranasal versed works as a great adjunct. Overall, I'm not a fan of sedation for a variety of reasons.

I'm super interested in the capabilities of nitrous though for quick procedures like these

 

[EM2BE]

I use ketamine the majority of the time for any case which requires sedation.

This actually brings up a point I have been trying to decide for my own style. Some studies say ketamine can decrease the seizure threshold in epileptics, some say it doesn't matter, and I found one source say it was affected in a dose-dependent manner (2-4mg/kg range). Do you change the sedative for epileptics?