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Paediatric procedural sedation and analgesia by emergency physicians in a country with a recent establishment of emergency medicine

Kuypers, Maybritt I.a,b; Smits, Gaël J.P.c; Baerends, Eva P.f; Oskam, Erickg; Reijners, Eef P.J.h; Mignot-Evers, Lisette A.A.i; Thijssen, Wendy A.M.H.c; Plötz, Frans B.j; Korsten, Erik H.M.d,e

European Journal of Emergency Medicine: June 2019 - Volume 26 - Issue 3 - p 168–173
doi: 10.1097/MEJ.0000000000000524
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Objectives Paediatric patients receive less procedural sedation and analgesia (PSA) in the emergency department compared with adults, especially in countries where emergency medicine is at an early stage of development. The objectives of this study were to evaluate the adverse events and efficacy of paediatric PSA in a country with a recent establishment of emergency medicine and to describe which factors aided implementation.

Methods This is a prospective, multicentre, observational study of paediatric patients undergoing PSA by the first trained emergency physicians (EPs) in The Netherlands. A standardized data collection form was used at all participating hospitals to collect data on adverse events, amnesia, pain scores, and procedure completion. A survey was used to interpret which factors had aided PSA implementation.

Results We recorded 351 paediatric PSA. The mean age was 9.5 years (95% confidence interval: 9.1–10.0). Esketamine was most frequently used (42.4%), followed by propofol (34.7%). The adverse event rate was low (3.0%). Amnesia was present in 86.8%. The median pain score was 2 (out of 10) for patients without amnesia. Procedures were successfully completed in 93.9% of the cases.

Conclusion Paediatric PSA provided by the first EPs in The Netherlands showed appropriate levels of sedation and analgesia with a high rate of procedure completion and a low rate of adverse events. Our paper suggests that EPs provided with a proper infrastructure of mentorship, training and guidelines can implement effective paediatric PSA.

aAcademic Medical Centre, Amsterdam

bTergooi Hospital, Hilversum

Department of cEmergency

dAnaesthesiology, Intensive Care and Pain, Catharina Hospital

eTechnical University, Eindhoven

fEmergency Department, Westfriesgasthuis, Hoorn

gEmergency Department, Albert Schweitzer Hospital, Dordrecht

hEmergency Department, St Elisabeth Hospital, Tilburg

iEmergency Department, Maxima Medisch Centrum, Veldhoven

jDepartment of Paediatrics, Tergooi Hospital, Blaricum, The Netherlands

Received 17 April 2017 Accepted 19 November 2017

Correspondence to Maybritt I. Kuypers, MD, Tergooi Hospital, PO Box 10016, 1201 DA Hilversum, The Netherlands Tel: +31 88 753 17 53; fax: +31 88 753 15 39; e-mail: m.i.kuypers@amc.uva.nl

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