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Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department Godambe SA; Elliot V; Matheny D; Pershad JPediatrics 2003[Jul]; 112 (1 Pt 1): 116-23PURPOSE: To compare the effectiveness of 2 medication regimens, propofol/fentanyl (P/F) and ketamine/midazolam (K/M), for brief orthopedic emergency department procedural sedation. This study was powered to compare recovery times (RT) and procedural distress as measured by the Observational Score of Behavioral Distress-revised (OSBD-r; range: 0-23.5 with 23.5 representing maximal distress). METHODS: We conducted a prospective, partially-blinded controlled comparative trial comparing intravenous P/F with K/M in a convenience sample of 113 patients aged 3 to 18 years old undergoing orthopedic procedural sedation. All medications were administered by the intermittent intravenous bolus method. An independent sedation nurse recorded total sedation time and RT. Effectiveness was measured using 6 parameters: 1) patient distress as assessed by independent blinded observers after videotape review using the OSBD-r; 2) orthopedic satisfaction score (Likert scale 1-5); 3) sedation nurse satisfaction score (Likert 1-5); 4) parental perception of procedural pain using a 0 to 100 mm Visual Analog Scale with the upper limit being "most pain"; 5) patient recall of the procedure; and 6) 1 to 3 week follow-up. RESULTS: RT and total sedation time were significantly less in the P/F group than in the K/M group (33.4 minutes vs 23.2 minutes). The mean OSBD-r scores during manipulation were 0.084 and 0.278 for the K/M and P/F groups, respectively. Although this difference was statistically significant (95% confidence interval for the mean difference -0.34 to -0.048), both regimens were successful in keeping the scores low. There was no statistical difference between the groups in the other measures of effectiveness. There was a statistically significant difference between the groups in the occurrence of desaturation and late side effects. CONCLUSIONS: RT with P/F is shorter than with K/M. P/F is comparable to K/M in reducing procedural distress associated with painful orthopedic procedures in the pediatric emergency department. Although propofol has a greater potential of respiratory depression and airway obstruction as compared with ketamine, it offers some unique advantages including a quicker offset and smoother recovery profile.|*Emergencies[MESH]|*Orthopedic Procedures[MESH]|Adolescent[MESH]|Analgesics, Opioid/*administration & dosage/adverse effects[MESH]|Child[MESH]|Child, Preschool[MESH]|Drug Combinations[MESH]|Emergency Service, Hospital/statistics & numerical data[MESH]|Female[MESH]|Fentanyl/*administration & dosage/adverse effects[MESH]|Hospitals, Pediatric/statistics & numerical data[MESH]|Humans[MESH]|Hypnotics and Sedatives/*administration & dosage/adverse effects[MESH]|Injections, Intravenous[MESH]|Ketamine/*administration & dosage/adverse effects[MESH]|Male[MESH]|Midazolam/*administration & dosage/adverse effects[MESH]|Propofol/*administration & dosage/adverse effects[MESH]|Prospective Studies[MESH]|Respiration Disorders/chemically induced[MESH]|Single-Blind Method[MESH]|Videotape Recording[MESH]|Wounds and Injuries/therapy[MESH] |
