The Efficacy of Rectal Thiopental According to the Enema Positions for Pediatric Sedation

PURPOSE: We wanted to compare the efficacy of rectal thiopental according to the enema position for pediatric sedation in the emergency department METHODS: One hundred sixty patients were sedated with rectal thiopental for CT or laceration repairs. The dosage of thiopental was 25 mg/kg and second dose was 15 mg/kg if the patient was not sedated. After administration, one group was positioned erect for 5 minutes and other group was positioned supine for 5 minutes. After the patients were sedated, we checked the Ramsay scales and the FLACC scales during compression by a BP cuff and/or injection of local anesthetics. All the patients were monitored for their oxygen saturation and their vital signs RESULTS: Successful sedations and adequate procedures were obtained in each group: 95.2% in the erect group and 94.7% in the supine group. The induction time and recovery time after the first injected dose were not significantly different between the groups: 16+/-6 min and 57+/-3 min in the erect group and 16+/-8 min, 61+/-4 min in the supine group. After second dose injection, the induction and recovery time were not different between both groups. The Ramsay scale and FLACC scale during compression by a BP cuff were not different in the two groups. As compared to the FLACC scale for measuring pain during injecting local anesthetics to repair lacerations, the percentage of patients who had their pain recorded via the FLACC pain scale as 0 were different; 25.9% in a erect group and 4.5% in a supine group. But the difference between the groups was not significat (p=0.1). There were no significant side effects during the total sedations. CONCLUSION: The efficacy when administrating rectal thiopental was not significantly different as related to the enema positions.

Comparison Analysis of Performance among the types of Intraosseous Needle in Animal Bone Models

PURPOSE: To compare each type of intraosseous needles for the performance. METHODS: Eighteen doctors participated. We chose chicken legs for the pediatric tibia model, and the metatarsal bone of swine for the adult humerus model, based on CT and bonedensitometry testing. We decided chicken legs for a pediatric tibia, metatarsal bones of swine for an adult humerus. Each doctor performed intraosseous insertion into the chicken leg 3 times per needle and 1 time per needle for the swine foot. In our study, we compared the following: intravenous needle (IV), spinal needle (SN), bone marrow aspiration needle (BN), Jamshidi needle (JN), and EZ-IO TM (EZ-IO). RESULTS: The success rate of EZ-IO, JN, BN, IV, and SN was 79.6%, 63%, 57.4%, 42.6%, 16.7%, respectively in the pediatric model. The bending or broken rate of IV and SN was 42.6% and 59.3%. The success rate of EZ-IO, JN, BN, SN, and IV was 83.3%, 44.4%, 33.3%, 22.2%, and 22.2%, respectively in the adult model and the success rate of the IO device, such as EZ-IO and JN was higher than in others. The time to insert was 18.9~32.0 seconds to all devices but SN, BN, IV had wide standard deviations. CONCLUSION: We suggest that using commercial intraosseous devices are more effective than using IV, SN, and BN to achieve vascular access in severely ill patients. Further study of real patient models is needed to clarify the usefulness of the devices demonstrating successful results in this study.