Adverse events during sedation for oro-dental trauma in an Israeli paediatric emergency department.

There is a paucity of data regarding the safety of the practice of sedation for oro-dental trauma in paediatric emergency departments (ED). A previous study reported the safety of intramuscular ketamine administered as a single agent. In the paediatric ED of a tertiary trauma centre in Israel, one of two ketamine-based regimens is used for sedating children with intraoral injuries according to the physician's discretion: a single dose of intramuscular ketamine or a combination of ketamine and propofol (KP) intravenously. The aim of this study was to assess the safety of KP sedation in children undergoing emergency treatment of oro-dental injuries in this paediatric ED. The primary outcome was sedation adverse events that required intervention (SAERI): prolonged oxygen desaturation and apnoea, laryngospasm, hypotension, bradycardia, partial or complete airway obstruction, and pulmonary aspiration. During the 2 years study period, 17 children were sedated with KP, 20 with intramuscular ketamine and 29 with nitrous oxide. Patients who were treated with ketamine-based sedation or with nitrous oxide sedation had a median (interquartile range, IQR) age of 3 (2-4) years and 7 (5-9) years, respectively. No SAERI occurred in patients who were sedated with intramuscular ketamine. One (3.4%) SAERI was reported in a patient who was sedated with N2 O. Six/17 (35%) SAERI occurred in patients who were sedated with KP. These findings suggest that caution should be used when young children with oro-dental injuries are sedated with KP in the ED.

Serious Adverse Events in Pediatric Procedural Sedation Before and After the Implementation of a Pre-Sedation Checklist.

OBJECTIVE: Procedural sedation is considered by the Joint Commission on Accreditation of Healthcare Organizations as a high-risk procedure when performed in the emergency department (ED). A pre-sedation checklist is a set of items checked before any sedation. We evaluated the impact of a pre-sedation checklist on the rate of serious adverse events (SAE) in a pediatric ED. METHODS: We conducted a retrospective study comparing the rate of SAE in children treated with the combination of ketamine and propofol before and after the implementation of a pre-sedation checklist. The before-and-after periods lasted from 1.1.2013 to 30.6.2016 and from 1.7.2016 to 30.6.2019, respectively. Patient data were extracted from the electronic medical records using an integrated business intelligence information system. RESULTS: The before-and-after cohorts included 1349 and 1846 patients, respectively. The two groups were similar with regard to age, sex, length and type of procedure, medications dosage, and level of physicians' training. A total of 183/1349 (13.5%) and 420/1846 (22.7%) SAE were recorded during the before-checklist and after-checklist periods, respectively (p<0.0001). The rates of laryngospasm, apnea, and oxygen saturation ≤90% at the before-and-after checklist periods were 9/1349 (0.6%) and 30/1846 (1.6%); p<0.05, 48/1349 (3.5%) and 77/1846 (4.2%); p=0.37, and 123/1349 (9.1%) and 312/1846 (16.9%); p< 0.0001, respectively. All the SAE were successfully managed by the emergency physicians and no patient required hospitalization due to a SAE. CONCLUSION: In this large cohort of ED children who underwent deep sedation, the administration of a pre-sedation checklist was not associated with a reduction in SAE rate.