Procedural sedation for fracture reduction in children with hyperactivity.

OBJECTIVE: Children with attention-deficit/hyperactivity disorder (ADHD) have a higher rate of more severe injuries than the general population. However, their ADHD may cause them to respond differently to procedural sedation required for treatment. The purpose of this article is to compare procedural sedation for children with and without ADHD. METHODS: Retrospectively, 44 patients with ADHD and 41 controls sedated with fentanyl and midazolam for forearm-fracture reduction in the emergency department (ED) at a children's hospital were identified. Drug dosages, vital signs, and sedation scores were compared. RESULTS: Drug dosages, vital signs, and sedation scores did not significantly differ between cases and controls. Mean ED visit duration was significantly longer for patients with ADHD than for controls as was sedation duration. CONCLUSIONS: Children with and without ADHD were equally sedated with the same total drug dosages. The differences in sedation duration and visit duration warrant further investigation.

Adverse events in pediatric ketamine sedations with or without morphine pretreatment.

OBJECTIVE: To assess outcomes between 2 groups of patients receiving ketamine for procedural sedations in our pediatric emergency department. Our hypothesis is that there is no difference in the number of adverse events in ketamine sedations with and without morphine pretreatment. METHODS: This was a retrospective cohort study of all ketamine sedation records over 15 months. The number and types of adverse events between patients with and without morphine pretreatment were examined. The numbers of adverse events in each group were compared using a z test. We also examined the possible influence of midazolam coadministration. P values were calculated using Pearson chi2 or Fisher exact tests. RESULTS: A set of 858 sedations were reviewed. Age, weight, and medication dosages were similar in each group. Twenty-one adverse events were recorded in the group of patients without morphine pretreatment. There were 13 adverse events in the group with morphine pretreatment. No significant differences were found for the number or types of events. There was no difference in the frequency of midazolam coadministration, Pearson chi2, P = 0.994, nor for the number of adverse events in each group, Fisher exact test, P = 0.465. The mean time from morphine administration to procedural sedation was 114.7 minutes. One adverse event occurred in the 15-minute or less time interval. CONCLUSIONS: We found no increase in the number of adverse events with morphine pretreatment in ketamine sedations for children. Prospective studies to validate these findings, including an effect of timing of analgesia administration, are warranted.