Experience with sedation and analgesia in a tertiary care hospital pediatric Emergency Department

BACKGROUND AND OBJECTIVE. Greater awareness of pain has led most pediatric emergency departments to create protocols for sedation and analgesia in the interest of improving quality of care and management of therapy. Our aim was to analyze how our pediatric emergency department uses sedation and analgesia.
MATERIALS AND METHODS. Observational cohort study of patients under the age of 14 years who required sedation plus analgesia during emergency treatment between March 2015 and March 2020. We analyzed demographic variables, procedures used to deliver sedation and analgesia, drugs used, pain and anxiety levels, and time in the department.
RESULTS. A total of 483 patients were studied; 68.5% (n = 331) were boys and 50% were under the age of 5 years. The procedure requiring sedation with analgesia most often was fracture reduction (in 30.7%, n = 149). Other painful procedures requiring sedation and analgesia, according to frequencies within age groups, were lumbar puncture in patients under the age of 1 year (in 47.36%, n = 18); wound closure in 1 to 5 year olds (in 33.05%, n = 78); and fracture reduction over the age of 5 years (in 48.57%, n = 102). Midazolam was the drug most often used (in 48.1%, n = 233), mainly combined with fentanyl (78.5%, n = 183), which was usually given via intranasal spray (61.8%, n = 144). The reduction in pain and anxiety was statistically significant (P < .001). Most patients experienced no adverse effects, either in the short term (86.2% n = 418) or long term (94%, n = 457). The correlation coefficient between degree of satisfaction of parents and health care personnel was 0.883 (P < .001).
CONCLUSIONS. Sedation with analgesia is effective for decreasing pain and anxiety during diagnostic and therapeutic procedures in pediatric emergency departments. The low incidence of adverse effects supports pediatricians’ use of these resources and generally favors early discharge.