Pediatric Procedural Sedation in the Emergency Department: An Exploratory Study

2.50
Hdl Handle:
http://hdl.handle.net/10755/162545
Type:
Presentation
Title:
Pediatric Procedural Sedation in the Emergency Department: An Exploratory Study
Abstract:
Pediatric Procedural Sedation in the Emergency Department: An Exploratory Study
Conference Sponsor:Emergency Nurses Association
Conference Year:2009
Author:Schmedel, Wayne, RN, BS, CCRN
P.I. Institution Name:Providence St. Vincent Medical Center
Title:Staff Nurse
Contact Address:9206 SW Barnes Road, Portland, OR, 97226, USA
Contact Telephone:503-216-2362
[Annual Conference Research Poster]
Purpose: Efficacy of the particular emergency department (ED) sedation agent was defined as having shorter procedural sedation time, absence of pulmonary or hemodynamic changes, and a deeper level of sedation achieved. Intramuscular (IM) ketamine and intravenous (IV) propofol were the agents that were compared.

Design: This was a retrospective observational non-randomized study of emergency department pediatric patients requiring procedural sedation.

Setting: A community non-profit 522 bed teaching hospital with a 50 bed emergency department was the research site.

Sample: 118 pediatric patients were studied and the specific children age group (n=61) of 2 to 12 years was used for comparison (33 received intravenous propofol and 28 received intramuscular ketamine). There were 12 females and 21 males who received IV propofol and 12 females as well as 16 males received IV ketamine. Approval for the study was obtained by the regional IRB.

Methodology: The first 118 pediatric patients who received either pediatric procedural sedation were enrolled into the study during a retrospective quality improvement audit for emergency department procedural sedation. Physiological variables (blood pressure, heart rate, respiratory rate, and oxygen saturation) were recorded at baseline and when the level of sedation was highest and notes were recorded if there were any physiologic compromise or complication during the entire procedural sedation. The Ramsey score was also continuously recorded which defined the level of sedation. Deep sedation was defined when the Ramsey score was either 5 or 6.

Results: Patients who received IM ketamine had a significant deeper level of sedation (mean 4.8) compared to IV propofol (mean 3.8) but propofol had a much shorter time of sedation monitoring (mean 36 minutes) compared to the patients receiving ketamine (68 minutes). Using the Student's t-test ketamine had a significant deeper level of sedation (p < 0.002) and propofol also had a significantly shorter procedural sedation time (p < 0.00004). There were no significant differences in physiologic variables between the two agents.

Conclusions: Ketamine (IM) when compared to propofol (IV) provides a much deeper level of sedation but propofol provides a much more rapid recovery time. The deeper level of sedation conceivably provides the patient with a more pleasant procedural sedation experience. The shorter procedural sedation time has implications of decreasing required health care resources and can directly reduce ED overcrowding.

Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePediatric Procedural Sedation in the Emergency Department: An Exploratory Studyen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162545-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Pediatric Procedural Sedation in the Emergency Department: An Exploratory Study</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Schmedel, Wayne, RN, BS, CCRN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Providence St. Vincent Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Staff Nurse</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">9206 SW Barnes Road, Portland, OR, 97226, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">503-216-2362</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">wayne.schmedel@providence.org</td></tr><tr><td colspan="2" class="item-abstract">[Annual Conference Research Poster] <br/> Purpose: Efficacy of the particular emergency department (ED) sedation agent was defined as having shorter procedural sedation time, absence of pulmonary or hemodynamic changes, and a deeper level of sedation achieved. Intramuscular (IM) ketamine and intravenous (IV) propofol were the agents that were compared. <br/> <br/> Design: This was a retrospective observational non-randomized study of emergency department pediatric patients requiring procedural sedation. <br/> <br/> Setting: A community non-profit 522 bed teaching hospital with a 50 bed emergency department was the research site. <br/> <br/> Sample: 118 pediatric patients were studied and the specific children age group (n=61) of 2 to 12 years was used for comparison (33 received intravenous propofol and 28 received intramuscular ketamine). There were 12 females and 21 males who received IV propofol and 12 females as well as 16 males received IV ketamine. Approval for the study was obtained by the regional IRB. <br/> <br/> Methodology: The first 118 pediatric patients who received either pediatric procedural sedation were enrolled into the study during a retrospective quality improvement audit for emergency department procedural sedation. Physiological variables (blood pressure, heart rate, respiratory rate, and oxygen saturation) were recorded at baseline and when the level of sedation was highest and notes were recorded if there were any physiologic compromise or complication during the entire procedural sedation. The Ramsey score was also continuously recorded which defined the level of sedation. Deep sedation was defined when the Ramsey score was either 5 or 6. <br/> <br/> Results: Patients who received IM ketamine had a significant deeper level of sedation (mean 4.8) compared to IV propofol (mean 3.8) but propofol had a much shorter time of sedation monitoring (mean 36 minutes) compared to the patients receiving ketamine (68 minutes). Using the Student's t-test ketamine had a significant deeper level of sedation (p &lt; 0.002) and propofol also had a significantly shorter procedural sedation time (p &lt; 0.00004). There were no significant differences in physiologic variables between the two agents. <br/> <br/> Conclusions: Ketamine (IM) when compared to propofol (IV) provides a much deeper level of sedation but propofol provides a much more rapid recovery time. The deeper level of sedation conceivably provides the patient with a more pleasant procedural sedation experience. The shorter procedural sedation time has implications of decreasing required health care resources and can directly reduce ED overcrowding.<br/><br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:30:00Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:30:00Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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