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Etomidate for Short Pediatric Procedures in the Emergency Department

Mandt, Maria J. MD*; Roback, Mark G. MD; Bajaj, Lalit MD, MPH*; Galinkin, Jeffrey L. MD; Gao, Dexiang PhD§; Wathen, Joseph E. MD*

doi: 10.1097/PEC.0b013e318267c768
Original Articles

Objective: This study aimed to prospectively determine the etomidate dose associated with adequate sedation and few significant respiratory events for procedures of short duration in children.

Methods: This is a prospective cohort study in an urban pediatric emergency department of patients 4 to 18 years requiring sedation and analgesia for painful procedures of short duration. Patients received fentanyl 1 μg/kg followed by intravenously administered etomidate 0.1 to 0.2 mg/kg as a loading dose. An additional dose of etomidate 0.1 mg/kg was intravenously administered if needed. The level of sedation was determined by The Children’s Hospital of Wisconsin Sedation Score. The primary outcome was to determine the etomidate dose associated with an adequate level of sedation and procedural completion.

Results: Sixty patients were enrolled. The most frequent procedure was fracture reduction (50/60, 83.3%). Procedures were successfully completed for 59 (98.3%) of 60 patients. The initial dose of etomidate associated with adequate sedation was 0.2 mg/kg intravenously administered for 33 (66.7%) of 50 patients requiring fracture reduction and for 6 (60.0%) of 10 patients receiving a procedure other than fracture reduction. Respiratory depression was noted in 9 (16.4%) of 55 patients, and oxygen desaturation was noted in 23 (39.0%) of 59 patients. Of 58 patients, 21 (36.2%) experienced a respiratory adverse event requiring brief intervention including oxygen supplementation, stimulation, and/or airway repositioning. No patient experienced a significant adverse respiratory event, defined as positive pressure ventilation. Median time to discharge-ready was 21 minutes.

Conclusions: For short-duration painful emergency department procedures, etomidate 0.2 mg/kg intravenously administered after fentanyl was associated with effective sedation, successful procedural completion, and readily managed respiratory adverse events in children.

From the *Department of Pediatrics, Section of Emergency Medicine, The Children’s Hospital, University of Colorado Denver Health Science Center, Aurora, CO; †Departments of Pediatrics and Emergency Medicine, University of Minnesota Medical School, Minneapolis, MN; and ‡Department of Anesthesiology, and §Clinical and Translational Research Center, The Children’s Hospital, University of Colorado Denver Health Science Center, Aurora, CO.

Disclosure: The authors declare no conflict of interest.

Reprints: Maria J. Mandt, MD, Department of Pediatrics, Section of Emergency Medicine, The Children’s Hospital, University of Colorado Denver Health Science Center, 13123 E 16th Ave, B251, Aurora, CO 80045 (e-mail: Mandt.maria@tchden.org).

The BIS monitor used for the study was supplied by Aspect Medical Systems and returned at study completion. There was no grant or other financial support for this study.

© 2012 Lippincott Williams & Wilkins, Inc.