Pediatric Analgesia and Sedation
Annals of Emergency MedicinePublished 1 February 1994
Alfred Sacchetti, Robert W. Schafermeyer, Michael Gerardi, John Graneto, Ronnie S. Fuerst, Richard M. Cantor
Citations151
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TL;DR
Emergency physicians should be competent in the use of multiple sedatives and analgesics and adequate equipment and monitoring, staff training, discharge instructions and continuous quality management should be an integral part of the ED use of these agents.
Abstract
Sedation and analgesia are essential components of the ED management of pediatric patients. Used appropriately, there are a number of medications and techniques that can be used safely in the emergency care of infants and children. Emergency physicians should be competent in the use of multiple sedatives and analgesics. Adequate equipment and monitoring, staff training, discharge instructions and continuous quality management should be an integral part of the ED use of these agents.
Keywords
Medicine
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206 Citations1990Myron Yaster, David G. Nichols +2 more
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150 Citations1992Joseph D. Tobias, Sean Phipps +2 more
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Anesthesia & AnalgesiaOral Midazolam in Children
148 Citations1992B. Craig Weldon, Mehernoor F. Watcha +1 more
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140 Citations1991Howard Bauchner, Chris Waring +1 more
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131 Citations1992Anne M. Hubbard, Richard I. Markowitz +3 more
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131 Citations1985Milap C. Nahata, Michael A. Ootz +1 more
The adverse effects of MPC were studied prospectively in 95 patients undergoing various procedures and suggest the need for frequent monitoring and specific dosing guidelines for MPC use in pediatric patients.
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130 Citations1992Saul Lebovic, David L. Reich +3 more
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128 Citations1991Shaiana Vilella Hartwig, Bradley J. Roth +1 more
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123 Citations1990Halim Hennes, Virginia Wagner +5 more
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116 Citations1988Myron Yaster, Jayant K. Deshpande
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115 Citations1993Eric L. Bloomfield, Thomas J. Masaryk +8 more
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Annals of Emergency MedicineConscious sedation in the emergency department: The value of capnography and pulse oximetry
115 Citations1992Seth W. Wright
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111 Citations1990Joel M. Bartfield, Paul Gennis +3 more
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Annals of Emergency MedicineNitrous oxide analgesia in a pediatric emergency department
111 Citations1989Alan S. Gamis, Jane F Knapp +1 more
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Journal of Pediatric PsychologyEffect of Mother Presence on Children's Reaction to Aversive Procedures
108 Citations1982Edward G. Shaw, Donald K. Routh
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103 Citations1992Philip D. Walson
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100 Citations1991John T. Wilson, R. Don Brown +5 more
The influence of initial temperature on the magnitude of the response to an antipyretic drug is a previously unappreciated finding with potential impact on pharmacodynamic investigations of antipYretic medications.
RadiologySedation in pediatric CT: national survey of current practice.
99 Citations1990Scott Keeter, Richard Benator +2 more
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American Journal of RoentgenologyIV Nembutal: safe sedation for children undergoing CT
98 Citations1988J D Strain, J B Campbell +2 more
The average dose of sedation was reduced when compared with IM Nembutal because the rapid onset of activity after IV administration allowed titration of dose to patient response.
Journal of Computer Assisted TomographyHigh Dose Chloral Hydrate Sedation for Children Undergoing CT
97 Citations1991Stephen B. Greenberg, Eric N. Faerber +1 more
It is concluded that high dose oral chloral hydrate provides safe and effective sedation for children undergoing CT.
Annals of Emergency MedicineA randomized, controlled trial of the use of music during laceration repair
95 Citations1991James J. Menegazzi, Paul M. Paris +3 more
Music provides a safe, inexpensive, and effective adjunct for the management of pain in the ED but does not significantly affect anxiety.
AnaesthesiaKetamine by continuous infusion in status asthmaticus
95 Citations1986Patrick Strube, P. L. HALLAM
Ketamine is a useful drug in the intensive treatment of status asthmaticus and should be tried before a decision is taken to start mechanical ventilation.
Pharmacotherapy The Journal of Human Pharmacology and Drug TherapyEtomidate: A New Intravenous Anesthetic Induction Agent
95 Citations1983Jeffrey L. Giese, Theodore H. Stanley
Etomidate is a non‐barbiturate hypnotic without analgesic properties that has less cardiovascular and respiratory depressant actions than sodium thiopental, even in patients with minimal cardiovascular reserve, and may have a place in neurosurgery and as a “brain protective” agent in patients at risk of a brain hypoxic insult.
AnesthesiologyRole of Nitrous Oxide and Other Factors in Postoperative Nausea and Vomiting
94 Citations1987Jesse J. Muir, Mark A. Warner +4 more
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92 Citations1972Guenter Corssen, JUAN F. GUTIERREZ +2 more
Annals of Emergency MedicineA prospective analysis of intramuscular meperidine, promethazine, and chlorpromazine in pediatric emergency department patients
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IM MPC is a safe and generally effective agent for ED procedures in selected children in an unblinded trial of physiologic responses and efficacy in children.
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88 Citations1974David R. Sussman
Seven per cent of patients less than 31 years old who received ketamine anesthesia developed problems leading to unsatisfactory anesthetic courses (loss of airway, muscular hypertonus, and inadequate analgesia); 34% of patients31 years old or older had unsatisfactory anesthesia.
Journal of Oral and Maxillofacial SurgeryDisinhibitory reactions to benzodiazepines: A review
86 Citations1991Pieter van der Bijl, J Roelofse
Some guidelines, which include the avoidance of certain drug combinations, the use of low doses of benzodiazepines, slow incremental intravenous administration, and good rapport with patients, are presented to minimize the occurrence of disinhibitory reactions.
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86 Citations1989Howard Bauchner, Robert J. Vinci +1 more
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PainThe importance of type of question, psychological climate and subject set in interviewing children about pain
83 Citations1984Dorothea M. Ross, Sheila A. Ross
Data obtained from a large‐scale interview project on children's views of their ongoing and past pain experiences provide some support for the interview methodology advocated here.
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82 Citations1989Lonnie K. Zeltzer, Susan Jay +1 more
The goals of intervention are presented, as well as issues warranting consideration in planning intervention to reduce procedure-related distress.
Annals of Emergency MedicineComparison of topical tetracaine, adrenaline, and cocaine anesthesia with lidocaine infiltration for repair of lacerations in children
82 Citations1990Mary A. Hegenbarth, Michael Altieri +4 more
A topical alternative, TAC solution (tetracaine 0.5%, adrenaline 1:2,000, cocaine 11.8%), with 1% lidocaine infiltration for use in laceration repair in 467 children found to be less effective on extremity wounds.
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80 Citations1976M. Ramez Salem, A. Y. WONG +3 more
It is concluded that because of its selective inhibitory effect on gastric acid secretions, glycopyrrolate appears superior to other anticholinergic drugs and bile staining of gastric contents is not a reliable indicator of Gastric juice pH.
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79 Citations1991Michael A. Clotz, Milap C. Nahata
All three fentanyl derivatives provide cardiovascular stability when administered before noxious surgical stimuli, except when given as a single bolus during the induction of anesthesia, and all seem to produce adequate anesthesia, particularly when used in combination with nitrous oxide.
Anaesthesia and Intensive CareOral Premedication in Children: A Comparison of Chloral Hydrate, Diazepam, Alprazolam, Midazolam and Placebo for Day Surgery
73 Citations1990Brian J. Anderson, H. Exarchos +2 more
Alprazolam and midazolam were unpalatable for children over four years and conferred no advantage over placebo, while chloral hydrate produced superior conditions (more patients calm or asleep) at induction of anaesthesia.
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73 Citations1989Leora Kuttner
Techniques that reduce pain and anxiety, including behavioral distraction, kinesthetic methods, and imaginal methods, are discussed and described using case examples, for the physician's management of children during acute painful procedures.
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73 Citations1988Peter T. Pons
Nitrous oxide, known since 1776, is perhaps the drug that comes closest to meeting the ideal of rapid onset, short duration, few side effects, and no major adverse reactions.
Clinical PediatricsSedation of Children for Technical Procedures
72 Citations1992Bruce A. Cook, James W. Bass +2 more
It is determined that departments of pediatrics set sedation policies for children in most institutions, often with formal written guidelines for these procedures, that require that children have some form of cardiorespiratory monitoring while under sedation and that they are attended by individuals trained in cardiorespiratory resuscitation until the child is fully recovered.
Annals of Emergency MedicineBuffered versus plain lidocaine for digital nerve blocks
70 Citations1993Joel M. Bartfield, David T Ford +1 more
Canadian Journal of Anesthesia/Journal canadien d anesthésieOral transmucosal fentanyl citrate for premedication in paediatric outpatients
68 Citations1990Michael A. Ashburn, James B. Streisand +8 more
The data indicate that OTFC may be a safe and effective premedicant in paediatric patients having short operations but delays discharge from the hospital by delaying the time patients tolerate fluids early after operation.
Annals of Emergency MedicineLocal anesthesia in pediatric patients: Topical TAC versus lidocaine
67 Citations1990AB Anderson, Catia Colecchi +2 more
A randomized, placebo-controlled, double-blind clinical study was conducted to test the hypothesis that topical TAC and intradermal lidocaine are equally efficacious with respect to patient compliance with the suturing process, ie, anesthetic application and placement of sutures, and development of wound complications.
AnesthesiologyOral Transmucosal Fentanyl Citrate for Preanesthetic Medication of Pediatric Day Surgery Patients with and without Droperidol as a Prophylactic Anti-emetic
67 Citations1992Robert H. Friesen, Charles Lockhart
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65 Citations1985Neil L. Schechter
This monograph has focused more attention on pharmacologic than on nonpharmacologic approaches to pain, this is merely a reflection of available data and not necessarily of relative importance.
AnesthesiologyVentilatory Response to CO2 Following Intravenous Ketamine in Children
64 Citations1989J. Hamza, Claude Ecoffey +1 more
It is concluded that clinically useful doses of iv ketamine significantly alter ventilatory control in children and the slope f/PETCO2 and the f 60 remained significantly decreased following ketamine infusion.
The American Journal of Emergency MedicineIntranasal midazolam as a sedative for children during laceration repair
63 Citations1992Donald M. Yealy, James H. Ellis +2 more
It is concluded that intranasal midazolam is a safe and effective sedative for laceration repair under local anesthesia in preschool-aged children and recommends a dose of 0.3 to 0.5 mg/kg, with treatment failure less likely after 0.4 to0.5mg/kg.
Annals of Emergency MedicineTAC use and absorption of cocaine in a pediatric emergency department
63 Citations1990Laura Fitzmaurice, Gary S. Wasserman +4 more
A study was undertaken to assess the systemic absorption of cocaine and its metabolites when TAC is used as a local anesthetic in children and no clinical sign of cocaine toxicity was observed in any child.
Annals of Emergency MedicineIntramuscular meperidine, promethazine, and chlorpromazine: Analysis of use and complications in 487 pediatric emergency department patients
57 Citations1989Thomas E. Terndrup, Richard M. Cantor +1 more
American Journal of OrthopsychiatryThe fear of needles in children.
56 Citations1985David Fassler
This study explores the effect of a single session, cognitively-based intervention program on needle fears in hospitalized children and demonstrates significant changes in behavior, heart rate, and pain perception associated with post-intervention injection.
Annals of Emergency MedicineEffectiveness and safety of intravenous nalmefene for emergency department patients with suspected narcotic overdose: A pilot study
55 Citations1993Justin L. Kaplan, John A. Marx
Nalmefene is effective in the reversal of opiate overdose and appears to be safe in the management of patients with altered sensorium in an open-label study in emergency department patients with possible narcotic overdose.
Southern Medical JournalEfficacy of Sedation of Children With Chloral Hydrate*
54 Citations1990CPT PETER D. RUMM, COL RICHARD T. TAKAO +2 more
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54 Citations1986Dabney M. Ewin
Annals of Emergency MedicineKetorolac for sickle cell vaso-occlusive crisis pain in the emergency department: lack of a narcotic-sparing effect
53 Citations1992Seth W. Wright, Robert L. Norris +1 more
The use of intramuscular ketorolac did not lead to a clinically significant reduction in the requirement for narcotics during the four-hour ED treatment period.
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53 Citations1991Robert T. Blouin, Pattilyn F. Conard +1 more
The authors conclude that propofol 2.5 mg.kg-1 iv produces longer-lasting depression of VeRCO2 than a 4.kg -1 iv dose of thiopental; after prop ofol, ventilatory depression may persist despite apparently complete recovery of consciousness.
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50 Citations1992S. Larsson, B. Asgeirsson +1 more
It is concluded that children undergoing strabismus surgery anesthetized with propofol/fentanyl had more episodes of peroperative bradycardia, a lower incidence of postoperative vomiting and a shorter recovery time, and were more apprehensive during the initial postoperative period than children anestetherized with thiopental/halothane.
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48 Citations1991R. D. M. Jones, Andrew Lawson +3 more
Flumazenil rapidly antagonized midazolam-induced hypnosis in children and was associated with minimal change in cardiorespiratory variables.
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48 Citations1989William G. Barsan, Donna Seger +5 more
Nalmefene was significantly more effective than naloxone in reversing sedation at 60, 90, and 120 minutes, and is an effective agent for the reversal of opiate-induced sedation after outpatient procedures.
Journal of Emergency MedicineThe administration of rectal diazepam for acute management of seizures
47 Citations1990Robert S. Seigler
Review of the recent literature concerning the efficacy of rectal administration of intravenous diazepam solution for the purpose of emergency management of seizures in children finds undiluted diazepAM intravenous solution administered per rectum is an excellent alternative.
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47 Citations1978Karen Olness, George Gardner
Canadian Journal of Anesthesia/Journal canadien d anesthésieRectal methohexitone for induction of anaesthesia in children
46 Citations1979Gerald V. Goresky, D. J. Steward
The use of rectal methohexitone does not significantly delay immediate or late recovery after short surgical procedures and the effets tardifs sont comparables lors of interventions chirurgicales de moins of 30 minutes.
PEDIATRICSSome Guidelines for Uses of Hypnotherapy in Pediatrics
46 Citations1978Karen Olness, George Gardner
More research into the imaginative skills of children may facilitate understanding of learning mechanisms and make it possible for professionals to prevent the loss of the natural imaginative capacities in children and enhance the ability of mature members of society to use these skills.
Annals of Emergency MedicineUse of tetracaine, epinephrine, and cocaine as a topical anesthetic in the emergency department
42 Citations1992Stephen A.D. Grant, Robert S. Hoffman
Until additional research is performed to establish the minimum effective dose of TAC and its potential toxicity and until FDA approval is granted, it is not think that it can be recommended as the drug of choice for pediatric facial and scalp lacerations in the ED.
AnesthesiologyMethohexital Plasma Concentrations in Children Following Rectal Administration
41 Citations1985Letty M. P. Liu, Pierre Gaudreault +3 more
Loss of consciousness after rectal administration of methohexital correlates well with the plasma concentration of the drug.
Acta Anaesthesiologica ScandinavicaGlycopyrrolate during ketamine/diazepam anaesthesia A double‐blind comparison with atropine
40 Citations1986F Mogensen, D Müller +1 more
There were no statistically significant differences with respect to salivation, blood pressure, heart rate, nausea and/or vomiting, unpleasant dreams and arousal time during induction of anaesthesia with ketamine and diazepam for alloplastic hip or knee surgery.
Children s Health CareEmpathic Versus Directive Preparation of Children for Needles
40 Citations1981Charles D. Fernald, James Jeffrey Corry
Annals of Emergency MedicineRectal thiopental compared with intramuscular meperidine, promethazine, and chlorpromazine for pediatric sedation
38 Citations1991John F. O’Brien, Jay L. Falk +2 more
Rectal thiopental is superior to this drug combination for pediatric sedation because it can be administered painlessly, has a more rapid onset and offset of action, and is of equal safety and efficacy at the dosage studied.
Journal of the American College of Emergency PhysiciansIntravenous regional anesthesia
38 Citations1977James R. Roberts
Intravenous regional anethesia is a safe and reliable alternative to general or other regional anesthesia techniques for use in the emergency department and requires minimal special equipment.
Pediatric Emergency CareConscious sedation of the pediatric patient for suturing
37 Citations1990WILL HAWK, Rebecca Crockett +2 more
No single drug or combination of drugs was used routinely in pediatric emergency departments to sedate children for suturing, and a meperidine-promethazine-chlorpromazine “cocktail” was chosen most frequently.
Pediatric Clinics of North AmericaThe Treatment of Pain in the Emergency Department
36 Citations1989Steven M. Selbst, Fred M. Henretig
The use of analgesic medications, local anesthetics, ketamine, and nitrous oxide as appropriate to emergency situations is outlined and the guidelines for outpatient sedation are reviewed.
American Journal of Health-System PharmacyRectal thiopental versus an intramuscular cocktail for sedating children before computerized tomography
36 Citations1980Gilbert J. Burckart, Thomas J. White TJ +3 more
British Journal of AnaesthesiaINTRAOCULAR PRESSURE CHANGES DURING RAPID SEQUENCE INDUCTION OF ANAESTHESIA: COMPARISON OF PROPOFOL AND THIOPENTONE IN COMBINATION WITH VECURONIUM
34 Citations1988R. K. Mirakhur, W. F. I. SHEPHERD +1 more
Intraocular pressure (IOP) was measured during rapid sequence induction of anaesthesia using thiopentone or propofol as the induction agent and vecuronium for neuromuscular blockade and the frequency of side effects was low in both groups except for a significantly greater reduction in arterial pressure in those receiving prop ofol.
Pediatric Emergency CareManaging pain in the pediatric emergency department
34 Citations1989Steven M. Selbst
It is often impossible to avoid inflicting pain on some children in the pediatric ED, and the proper management of this pain is thus essential, with a variety of narcotic and nonnarcotic analgesics, as well as local and topical anesthetics.
Annals of Emergency MedicineAdrenaline-cocaine gel topical anesthetic for dermal laceration repair in children
34 Citations1992William Bonadio, Virginia Wagner
Compared with conventional adrenaline-cocaine liquid, adrenaline- cocaine gel may be advantageous in reducing the total cocaine requirement and may diminish the risk for adverse reactions that can result from runoff of liquid medication onto mucosal or ocular surfaces.
Annals of Emergency MedicineThe efficacy and safety of methohexital in the emergency department
33 Citations1991Brian J. Zink, Karen Darfler +2 more
MTX, when used by trained personnel who adhere to an established protocol, appears to be a safe and effective drug in selected ED patients.
The American Journal of Emergency MedicineChloral hydrate for emergent pediatric procedural sedation: A new look at an old drug
32 Citations1991Louis S. Binder, Lawrence Leake
It is hypothesized that chloral hydrate is safe and effective for ED pediatric sedation, and ninety-five consecutive children ranging from 1-10 years and requiring procedural intervention in a municipal teaching hospital ED were included in a nonrandomized controlled trial.
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30 Citations1985Roy G. Farrell, Steven L Swanson +1 more
The mini-dose Bier block creates the potential for significant cost savings in cases previously treated in the operating room by providing a safe, effective technique of IV regional anesthesia for outpatient use.
Journal of Toxicology Clinical ToxicologyThe Use Of Flumazenil In A Neonate
29 Citations1991Patrick O. Richard, E Autret +5 more
Side effects of benzodiazepines used during pregnancy are described in a neonate and recurrent apnea was reversed after administration of flumazenil, a specific antagonist of Benzodiazepine.
Clinical PediatricsPatient-Controlled Analgesia With Fentanyl in Children
28 Citations1992Joseph D. Tobias, Donald K. Baker
Fentanyl delivered by PCA provides an effective alternative when adverse effects occur with other more frequently used narcotics and appears to provide an acceptable alternative to "more conventional" narcotics.
Pediatric Emergency CareTAC
26 Citations1989William Bonadio
Agent anesthesique local contenant tetracaine adrenaline et cocaine, Proprietes efficacite anesthesiques, complications.
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