Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice


Sahyoun C., Cantais A., Gervaix A., Bressan S., Lollgen R., Krauss B.

EUROPEAN JOURNAL OF PEDIATRICS, vol.180, no.6, pp.1799-1813, 2021 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 180 Issue: 6
  • Publication Date: 2021
  • Doi Number: 10.1007/s00431-021-03930-6
  • Journal Name: EUROPEAN JOURNAL OF PEDIATRICS
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, CAB Abstracts, CINAHL, EMBASE, MEDLINE
  • Page Numbers: pp.1799-1813
  • Keywords: Pediatrics, Hypnotics and sedatives, Ambulatory surgical procedures, Procedural sedation and analgesia, Non-pharmacological approaches, Emergency medicine, RANDOMIZED CONTROLLED-TRIAL, INTRANASAL DEXMEDETOMIDINE, CHLORAL HYDRATE, PAIN MANAGEMENT, ADVERSE EVENTS, OPERATING-ROOM, ANESTHESIA, PROPOFOL, KETAMINE, IMPACT
  • Dokuz Eylül University Affiliated: Yes

Abstract

Procedural sedation and analgesia outside the operating theater have become standard care in managing pain and anxiety in children undergoing diagnostic and therapeutic procedures. The objectives of this study are to describe the current pediatric procedural sedation and analgesia practice patterns in European emergency departments, to perform a needs assessment-like analysis, and to identify barriers to implementation. A survey study of European emergency departments treating children was conducted. Through a lead research coordinator identified through the Research in European Pediatric Emergency Medicine (REPEM) network for each of the participating countries, a 30-question questionnaire was sent, targeting senior physicians at each site. Descriptive statistics were performed. One hundred and seventy-one sites participated, treating approximately 5 million children/year and representing 19 countries, with a response rate of 89%. Of the procedural sedation and analgesia medications, midazolam (100%) and ketamine (91%) were available to most children, whereas propofol (67%), nitrous oxide (56%), intranasal fentanyl (47%), and chloral hydrate (42%) were less frequent. Children were sedated by general pediatricians in 82% of cases. Safety and monitoring guidelines were common (74%), but pre-procedural checklists (51%) and capnography (46%) less available. In 37% of the sites, the entire staff performing procedural sedation and analgesia were certified in pediatric advanced life support. Pediatric emergency medicine was a board-certified specialty in 3/19 countries. Physician (73%) and nursing (72%) shortages and lack of physical space (69%) were commonly reported as barriers to procedural sedation and analgesia. Nurse-directed triage protocols were in place in 52% of the sites, mostly for paracetamol (99%) and ibuprofen (91%). Tissue adhesive for laceration repair was available to 91% of children, while topical anesthetics for intravenous catheterization was available to 55%. Access to child life specialists (13%) and hypnosis (12%) was rare.