Pediatric procedural sedation
Started by Aesculapius
For facial lacs I use intra-nasal versed.
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.
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.
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.
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.
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.
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.
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
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
-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
-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
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?
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?
